A massive scale-up of humanitarian aid in Bangladesh is needed to avoid a huge public health disaster following the arrival of hundreds of thousands of Rohingya refugees from Myanmar.

After a wave of targeted violence against the Rohingya, more than 620,000 people have fled to Bangladesh from Rakhine State in  Myanmar since August 25. The most recent influx of Rohingya refugees has added to the hundreds of thousands of who fled across the border during episodes of violence in previous years, bringing the total number now seeking shelter in Bangladesh close to one million.

Most of the newly arrived refugees have moved into makeshift settlements without adequate access to shelter, food, clean water, or latrines. Two of the main pre-existing settlements in Kutupalong and Balukhali have effectively merged into one densely populated mega-settlement of nearly 500,000 people, making it one of the largest refugee concentrations in the world.

“These settlements are essentially rural slums that have been built on the side of the only two-lane road that runs through this part of the district,” says Kate White, MSF’s emergency medical coordinator. “There are no roads in or out of the settlement, making aid delivery very difficult. The terrain is hilly and prone to landslides, and there is a complete absence of latrines.”

 

MSF President Dr. Joanne Liu on the Rohingya crisis in Bangladesh and Myanmar: 'People are in survival mode'

October 26, 2017 — Doctors Without Borders/Médecins Sans Frontières (MSF) International President Dr. Joanne Liu, a physician from Montreal, recently visited Cox’s Bazar, Bangladesh, where a refugee crisis is unfolding after renewed violence in Rakhine State, Myanmar. On October 23, she spoke at a Pledging Conference for the Rohingya Refugee Crisis organized by UN agencies, and called for more organizations to prevent what she called a "public-health time-bomb."

"There are almost no services available and the vulnerability of people’s living conditions is shocking," she says. "Whole families are living under plastic sheeting in muddy and flood-prone terrain. They have very few belongings, are vulnerable to attacks from elephants, and have no access to clean water, latrines, food or healthcare.

"It’s a very fresh displacement and people are in survival mode, which you can clearly see in everybody’s body language. People are taking each day as it comes, trying to secure the basics to get through the day. Currently the humanitarian response is quite scattered: plastic sheeting is handed out in one location, while bags of rice or water are distributed elsewhere."

Bangladesh: Voices from the Violence — an MSF Exodus photo story

Bangladesh

Over 620,000 refugees have arrived in a very short period and the scale of the crisis shows little of abating soon. Their arrival comes on top of hundreds of thousands of other Rohingyas who  arrived in previous years and were already living in difficult conditions. MSF teams had already expanded activities in response to the influx of Rohingya last October, but this new influx is pushing all actors to the limit. Camps are severely congested and refugees are in urgent need of food and clean drinking water. If the situation doesn’t improve there is a big chance of a public health emergency. 

Humanitarian aid should increase significantly. More actors are required to cope with the big amount of refugees, funding should be made available and the Government of Bangladesh needs to facilitate access for these organisations. 

Myanmar

MSF is extremely concerned that the Rohingya remaining in Central or North Rakhine may soon be forced to flee. Those that remain are currently unable to access medical care, food and other necessary items in Rakhine State, Myanmar.

Independent international humanitarian organizations are still blocked from accessing and operating in northern Rakhine. The Government of Myanmar has decided to work with only a select group of organizations, such as the Myanmar Red Cross, in providing aid. MSF is very concerned that the Myanmar government, who is party to the conflict, would restrict the delivery of humanitarian aid to handpicked organizations only. Not only are the needs higher than the capacity of said organization, but furthermore MSF is urging unfettered access to Rakhine State to ensure the impartial delivery of aid to those in need.

MSF is against the Government of Myanmar establishing camps for internally displaced persons (IDPs) or returnees in northern Rakhine, as this will exacerbate the ongoing segregation between Rakhine and Rohingya communities and will further complicate long term solutions.

MSF medical action for Rohingya refugees in Cox's Bazar, Bangladesh

Number of projects: 15 clinics and health posts, and two mobile clinics

Number of national and international staff: 861

Number of patients treated since August 25: more than 62,000

Main morbidities: respiratory infections, skin diseases and diarrheal diseases

Other activities: water and sanitation, mental health support

November 17, 2017 — Matching the influx of people crossing over the border from Myanmar since August 25, MSF has treated more than 62,000 patients in the Cox’s Bazar area. The main theme among these patients is respiratory tract infections, diarrheal diseases and increasing cases of infant malnutrition, all of which are directly related to the poor living conditions in the settlements, in particular the shelter and water and sanitation conditions.

The in-patient capacity at the existing Kutupalong clinic increased from 50 to 70 beds, with new wards and isolation capacity prepared for infectious diseases. The Kutupalong clinic remains MSF’s largest health facility in Cox’s Bazar.  

In October, MSF opened a second in-patient facility in Balukhali with a 50-bed capacity and a focus on mother and child health. MSF plans to open two additional in-patient clinics in the region by the end of November and end of December, respectively.

In less than three months, MSF has substantially expanded its capacity to respond to the increase in population. MSF has set up 15 health posts and two mobile clinics to help address the primary health care needs of the population.

Water and sanitation

Outside of the medical response, improving water and sanitation is a major part of our attempts to prevent the spread of disease. MSF has built more than 510 latrines, 105 boreholes and a gravity water supply system while trucking an average of 55m3 of water to the settlements daily.

MSF is targeting its water and sanitation response in the most difficult to reach areas where the needs are greatest. Latrine and water point construction is planned in coordination with the DPHE and other water and sanitation actors.

MSF also includes water supply and sanitation in its emergency response for new arrivals. MSF has deployed teams to arrival, transit and settlement locations to ensure that newly arrived refugees have access to safe drinking water and adequate sanitation facilities.

Between now and the end of December, MSF aims to install a total of 400 boreholes and 1,000 latrines in the Balukhali and Kutupalong Makeshift Settlements

Treating survivors of sexual and gender-based violence

Since August 25, MSF has treated 78 survivors of sexual violence at MSF’s Sexual and Reproductive Health Unit in Kutupalong.

More than 90 per cent of these survivors are Rohingya women and girls who have fled Myanmar since August. Fifty per cent of survivors are under the age of 18, including several under the age of ten.

But MSF believes these cases represent just a fraction of the actual number of Rohingya women and children who’ve been sexually assaulted.

Women are often reluctant to seek services, owing to a number of factors including the shame and stigma associated with sexual assault, a lack of awareness about the medical and psychological support available, and the uncertainty about what will happen if they do seek assistance.

In the early stages, after fleeing from violence and trauma, survivors are also more likely to be focused on basic survival needs, including finding shelter and food.

MSF has specialized staff on the ground to treat men, women and children who are referred for treatment as a result of trauma, including sexual assault and rape.

In the coming weeks, as people being to process the trauma they experienced in Myanmar, and as some of these women and girls might have become pregnant as a result of rape, MSF expects to see more SGBV survivors seeking medical care.

In a bid to ensure women, children and men are able to access medical care, including psychological treatment, MSF’s local community outreach workers are visiting the people living in the settlements in Cox’s Bazar, informing them about the free services the organisation offers, including treatment for SGBV.

Other Activities

MSF is supporting the government in expanding routine vaccination in the camps, ensuring that children aged between 6 months to 15 years are vaccinated against rubella and measles with the MR vaccine. Children under two will also receive the oral polio, PCV and Penta vaccines. MSF staff at all health facilities will have the capacity to administer immunization boosters. The number of suspected measles cases has been increasing in the camp over the past weeks, with MSF inpatient departments admitting up to 20 severe patients per day in the second week of November. The government ministry of health is conducting a measles mop-up campaign starting November 18, which will run for 12 days and aim at vaccinating a total of 270,800 children between the ages of 6 months and 15 years. MSF will be supporting this campaign with community mobilization, site identification, logistics, and transportation of vaccines. 

 

Rohingya refugees in Bangladesh: Immediate action needed to avert massive public health disaster

September 21, 2017 — A massive scale-up of humanitarian aid in Bangladesh is needed to avoid a massive public health disaster following the arrival of hundreds of thousands of Rohingya refugees, says the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF).

Following a wave of targeted violence against Rohingyas, more than 422,000 people have fled to Bangladesh from Rakhine State in Myanmar within a three week period. The most recent influx of Rohingya refugees has added to the hundreds of thousands of Rohingyas who fled across the border during episodes of violence in previous years.

Most of the newly arrived refugees have moved into makeshift settlements without adequate access to shelter, food, clean water, or latrines. Two of the main pre-existing settlements in Kutupalong and Balukhali have effectively merged into one densely populated mega-settlement of nearly 500,000 refugees, making it one of the largest refugee concentrations in the world.

“These settlements are essentially rural slums that have been built on the side of the only two-lane road that runs through this part of the district,” says Kate White, MSF’s emergency medical coordinator. “There are no roads in or out of the settlement, making aid delivery very difficult. The terrain is hilly and prone to landslides, and there is a complete absence of latrines. When you walk through the settlement, you have to wade through streams of dirty water and human feces.”

 

Myanmar: International humanitarian access to Rakhine State must urgently be permitted

September 18, 2017 — International humanitarian organizations must immediately be granted independent and unfettered access, including for international staff, to alleviate massive humanitarian needs in Rakhine State, Myanmar, says the international medical humanitarian organization Doctors Without Borders/ Médecins Sans Frontières (MSF).  

The call for urgent access comes amidst the ongoing military operations in Rakhine, which started on August 25 after a new spate of attacks against police stations and a military base claimed by the Arakan Rohingya Salvation Army (ARSA). As a consequence, over 400,000 Rohingya have fled to Bangladesh and are living in extremely precarious conditions with limited access to health care, potable water, latrines and food.

The remaining population in Northern Rakhine, thought to be hundreds of thousands of people, is without any meaningful form of humanitarian assistance. “Our teams in Bangladesh are hearing alarming stories of severe violence against civilians in Northern Rakhine. Reports are that there is significant internal displacement of Rohingya, ethnic Rakhine populations and other minorities. Villages and houses have been burned down, including at least two out of four of MSF’s clinics. Prior to being put on hold due to a lack of travel authorization and a ban on international staff in mid-August, MSF was providing healthcare services in Maungdaw and Buthidaung townships in Northern Rakhine. We fear that those remaining there are unable to access the help they may need,” says Karline Kleijer, emergency desk manager at MSF. “Injured, sick or chronically ill people in Northern Rakhine must be accessed without further delay, while emergency healthcare and other humanitarian assistance should be provided.”

 

Rohingyas: MSF scaling up activities in Bangladesh while concerned about those still in Myanmar

September 6, 2017 — Rohingya refugees fleeing to Bangladesh are in urgent need of medical and humanitarian assistance as an already dire humanitarian situation along the border with Myanmar worsens, says the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF).

By September 6, over 146,000 people had crossed into Bangladesh, fleeing violence in Rakhine state, Myanmar. This figure, coming on top of 75,000 people who have arrived since violence began in October 2016, represents one of the largest influxes ever of Rohingyas into Bangladesh. The majority of the new arrivals are now staying in existing makeshift settlements or UNHCR-registered camps, in three new makeshift camps that have emerged, or among the host community. Many refugees are stranded in no-man’s land between the borders of Bangladesh and Myanmar. Even prior to the most recent influx, many Rohingya refugees in Bangladesh lived in unsafe, overcrowded and unhygienic conditions with little protection from the elements.

“We’ve not had something on this scale here in many years,” says Pavlo Kolovos, MSF head of mission in Bangladesh. “Our teams are seeing streams of people arriving destitute and extremely traumatized, and who have had no access to medical care. Many of the arrivals have serious medical needs, such as violence-related injuries, severely infected wounds, and advanced obstetric complications. Without a scale-up of humanitarian support, the potential health risks are extremely concerning.”

One 49-year old father told MSF: “I fled home with my whole family, but my son was shot while running away. I brought him to the hospital here in Bangladesh, but left the other family members in the forest in Myanmar, in the open air, just hiding there. I haven’t heard from them for days now. I don’t know what to do, I feel so desperate.”

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