As efforts to respond and recover from the COVID-19 pandemic are ongoing globally, the strained healthcare services for the already conflict-traumatised populations in Bangladesh also need attention. The plight of over 600,000 Rohingya refugees in Cox’s Bazar—hosted in two registered camps (Kutupalong and Nayapara) and other areas—is intensifying. Bangladeshi healthcare workers have expressed concerns over the lacking test kits and challenges of social (physical) distancing. The health system has been stretched by a double burden of local Bangladeshi population and the Rohingya refugees (officially referred to by the Bangladeshi Government as ‘Forcibly Displaced Myanmar Nationals (FDMNs)), both exposed and vulnerable to the pandemic. With limited access and availability of resources in the camp settlements, health workers are finding it increasingly difficult to predict, prepare, and respond to the unfolding crisis amidst also the impact of cyclone Amphan and the impending monsoons.
Health systems for COVID-19 in Cox’s Bazar
On 14 May 2020, the first Rohingya refugee tested positive for COVID-19 along with another person in Cox’s Bazar. At the time, there were 18,863 positive cases in Bangladesh. COVID-19 preparedness and response in the 34 refugee camps in Cox’s Bazaar include delivery of critical assistance and services, dissemination of COVID-19 messages by over 2,000 Rohingya and Bangladeshi volunteers, the establishment of Severe Acute Respiratory Infection Isolation and Treatment Centres (SARI ITCs), and support to District facilities in Ramu, Chakaria, Sadar Hospital, and the Upazila health complexes. Humanitarian organisations have initiated a ‘Training of Master Trainers for Infection Prevention and Control (IPC)’ programme that will train other healthcare workers, including 180 cleaners at Sadar Hospital. To spread COVID-19 awareness, announcements are being made through loudspeakers and megaphones on CNG/Tomtom auto-rickshaws in all 34 camps and the Sadar, Pekua, Maheskhali, and Kutubdia areas of Cox’s Bazar. Sixty-five information service centres are operational in the camps, four of which handle community feedback and provide additional information to the host community.
Through interviews with Bangladeshi academics from the University of Dhaka and BRAC University, we learnt that key emerging challenges include limited testing capabilities, requirement for intensive care capacity and skilled medical staff, and shortage of Personal Protective Equipment (PPE). Some reports indicate a ‘COVID-19 fatigue’ expressed by the refugees, resulting in fewer people attending awareness sessions for preventive measures. The large host and refugee populations will require additional capacities for testing and contact tracing – especially for the Rohingyas, many of whom are unregistered. Delays in the timely diagnosis and treatment of infected refugees in camps could promote the spread of COVID-19 and constitute a bigger health issue. More vulnerable groups are the elderly, children, disabled individuals, people with pre-existing health conditions, and pregnant women.
As Prof. Humayun from the University of Dhaka mentioned: “Lockdown hasn’t emerged to be effective. Market places and town centres remain crowded, due to the festivities of Ramzaan. Considering the immense loss of the livelihoods of the employees involved in many shops in Dhaka and other cities, the government has decided to make the shopping centres open since 10 May.”
Double tragedy for the Rohingyas
If losing their home and nationality wasn’t a big enough loss, the Rohingya refugees are desperately burdened by the double impact of COVID-19 and Cyclone Amphan. Ten million people in Bangladesh were severely impacted by the cyclone, with half a million families potentially having lost their homes. Preliminary reports indicate that damage in Cox’s Bazar is minimal: approximately 300 shelters damaged and 60 fully destroyed. Although Cox’s Bazar has been comparatively less affected by the cyclone than other regions in Bangladesh, in the aftermath, telecommunications have been disrupted in the camps and nearby host communities and maintaining social distancing in the densely populated camps and relief shelters has been difficult. Meanwhile, COVID-19 positive cases in Cox’s Bazar refugee camps are increasing, with 29 confirmed cases as of 27 May 2020, making it difficult to trace, test, and isolate patients.
Health education through mass communication, social mobilization, advocacy, and behavioural intervention has shown to promote the adoption of healthy practices by disaster-affected populations. These alone cannot ensure safer and better recoveries for the Rohingya refugee populations, though. Their voices and participation are key to shaping a future where the FDMNs have an equal say in decisions concerning them. Maintaining essential services for displaced populations will be critical in reducing COVID-19 deaths and adverse health effects. This requires understanding and prioritizing their health needs, ensuring the safety of humanitarian workers, and access to affected populations.