Bangladesh, one of the world’s most densely populated countries, is also home to the world’s largest refugee camp. Across the Cox’s Bazar area of southeastern Bangladesh, nearly one million Rohingya refugees who fled targeted violence in neighboring Myanmar now live in overcrowded, unsanitary camps. As the novel coronavirus pandemic spreads through Bangladesh, Doctors Without Borders/Médecins Sans Frontières (MSF) country representative Paul Brockmann reflects on the current situation for Rohingya refugees, and the medical and logistical challenges COVID-19 will pose to the medical humanitarian response.
Running medical activities in the world’s biggest refugee camp is challenging enough at the best of times. Maintaining these amid the biggest global health crisis of our time is nothing less than Herculean.
MSF has been rapidly scaling up our facilities to respond to COVID-19 in Bangladesh, with isolation beds available in our projects in Cox’s Bazar district. We have rolled out tailored COVID-19 training for all staff, on everything from basic infection prevention and control measures to protocols on managing patients with COVID-19. An effective medical response to COVID-19 requires more than isolation beds, however. We need sufficient staff and medical supplies to protect them and to treat patients, to ensure continuity of care for our other patients, and to ensure effective community engagement and trust.
One of the immediate impacts of the pandemic has been the erosion of trust. Bangladeshi and Rohingya people are understandably frightened. Rumors and misinformation are rampant, and this is endangering people’s access to care. Tragically, one widely believed rumor amongst Rohingya refugees is that if they are found to have COVID-19, they will be taken from their families and killed.
These fears are keeping people in need of essential (non-COVID-19) treatment away from clinics. Over the last few weeks, we have seen a stark decline in patient numbers. Our facilities have emptied; we are seeing half the number of patients we would normally.
Before COVID-19, our Kutupalong hospital normally saw 80 to 100 patients a day for wound dressings—many for chronic wounds, which need regular cleaning and dressing every two or three days to prevent infection. At present, our medical staff are only seeing around 30 of these patients a day. Without treatment, dressings are likely to become soaked and dirty, risking infection, which can lead to sepsis and possibly even death. Community engagement and empowerment.