How WHO, Bangladesh, others curtail disease outbreaks, save lives among Rohingya refugees

In the past year concerted efforts by the Bangladesh Government, WHO and health partners have helped save thousands of lives, and prevented and rapidly curtailed deadly disease outbreaks among the nearly one million Rohingya refugees, who despite these efforts remain vulnerable even today with their evolving health needs, and severe funding crunch threatening continuity of life saving health services in their camps.
“Unprecedented efforts have been made in the last year and in the most challenging conditions. Deadly diseases such as cholera have been prevented, and measles and diphtheria curtailed rapidly with quick roll-out and scale-up of health services and mass vaccination campaigns. It is remarkable that not only has the mortality rate among the Rohingyas remained lower than expected in an emergency of such a scale, it has also reduced significantly in the last six months”, said Dr Poonam Khetrapal Singh, Regional Director, WHO South-East Asia, commending the Government of Bangladesh and health partners’ work on the ground.
The arrival of nearly 700,000 Rohingyas in Cox’s Bazar beginning 25 August 2017 was one of the largest ever population influxes over such a short span of time. Women, children and the elderly arrived with injuries, low immunization coverage, high rates of malnutrition, in need of reproductive health care and psycho-social support, and at risk of deadly disease outbreaks. In response, WHO, with the Ministry of Health and Family Welfare, coordinated emergency health services provided by the nearly 107 health partners on the ground, to ensure access to essential services for the Rohingyas across the area they settled – in mega and small camps, and many with their host communities.
In the last year, 155 health posts have been established, each catering to around 7700 people. In addition, 60 primary health care facilities covering 20,000 people each, and 11 secondary care facilities being accessed by nearly 115,000 people each have also been established. With generous support from KSrelief, 86 staff has been added to the workforce of the Cox’s Bazar district hospital, the only facility providing referral services to the vulnerable population and the host community.
“We have done things that collectively we can be proud of. However, we need to continue to support the health needs of this vulnerable population and remain vigilant against the spread of diseases. This is still a very fragile situation,” said Dr Peter Salama, WHO’s Deputy Director-General for Emergency Preparedness and Response, who recently visited the Rohingya camps in Cox’s Bazar.
Four million doses of vaccines against cholera, polio, measles and rubella and diphtheria and tetanus have been administered to children, adolescents and adults through multiple mass vaccination campaigns, preventing major disease outbreaks and saving thousands of lives. Childhood immunization has been established with 94 sites delivering lifesaving vaccines to children across the Rohingya camps.
WHO helped establish and strengthen disease surveillance to enable early detection and timely response to outbreaks, as the Rohingyas settled in crowded camps with suboptimal water and sanitation conditions, prone to water and vector borne diseases such as cholera, polio, measles, malaria, chikungunya etc. At least 152 health facilities covering 98% of the population are now implementing disease surveillance through the Early Warning Alert and Response System.
Laboratory capacity has been strengthened in Dhaka and established in Cox’s Bazar, while field health facility staff continues to be trained in the use of diagnostics for diseases such as malaria.
Coordinating monsoon contingency plan, preparedness and response for acute watery diarrhea, and diphtheria outbreak, WHO has delivered nearly 175 tons of medicines and supplies and pre-positioned emergency supplies in three locations for the monsoon and cyclone season. WHO has distributed water filters prioritizing health posts and centers and households with pregnant women.
WHO continues to build the capacity of health workers to provide mental health and psychosocial support services to the Rohingya refugees.
Despite these efforts, challenges remain. Floods and landslides in the ongoing monsoon season continue to displace people and affect the functioning of health facilities. The Rohingya population is reluctant to access sexual and reproductive health services, and as a result 70% of births are still taking place outside of health facilities.
The biggest challenge is the need to further scale up services to meet the complex, evolving and long term health needs of this highly vulnerable population amidst a funding shortfall that also threatens to undo the gains and progress made so far.
WHO has appealed for US$ 16.5 million for its continued support to the Rohingya response, which is part of the US$ 113.1 million being sought by all health partners together under the Joint Response Plan until March 2019.
Thanking all partners who have contributed to health response in Cox’s Bazar, Dr Bardan Jang Rana, WHO Representative to Bangladesh, said, “We need generous and continued support of our partners. It is important that the Rohingya people do not suffer anymore. We need to find sustainable ways of meeting their needs for health, water, sanitation, education, and livelihood.”