13 January, 2018
Unclean water, crowded shelters and dirty conditions create a perfect environment at the Balukhali refugee camp for spread of preventable diseases. The camp is in Cox's Bazaar, a town in southeastern Bangladesh. It is home to some of the estimated 650,000 Rohingya Muslims who fled unrest in neighboring Myanmar. More than 200 mobile vaccination teams have given about 900,000 doses of oral cholera vaccine to the refugees. However, another contagious bacterial infection, diphtheria, has appeared. "Diphtheria is a vaccine preventable disease," notes Kate Nolan. She works for the international aid group Medecins Sans Frontieres, or Doctors Without Borders. Nolan added that the appearance of diphtheria shows the Rohingya did not have good health care in Myanmar, also known as Burma. The disease often causes the buildup of a sticky grey-white substance in the nose or throat. The infection makes breathing difficult and damages the heart and central nervous system. Without diphtheria medication, death is possible.
Navaratnasamy Paranietharan is the World Health Organization representative to Bangladesh. He says the refugees have low vaccination rates. He believes conditions in the camp could lead to the appearance of "infectious diseases like cholera, measles, rubella and diphtheria." Health care in Myanmar is considered among the worst in the world, especially in areas where conflict and poverty have delayed medical development. The Rohingya Muslims fled Myanmar's northern Rakhine state after militants attacked security forces in late August. Myanmar's military answered the attack with an operation that some observers have called ethnic cleansing. Myanmar's government denies it is involved in ethnic cleansing. The government says a majority of the violence and burning of Rohingya villages was the work of Rohingya militants who attacked security forces. "Just a small amount of the needs were being met, even before the attacks in August," noted Chris Lewa, an expert on Rohingya. Lewa is with the Arakan Project, a human rights organization that studies and documents the situation. She said that health care in Rakhine state was very bad before the violence. According to Lewa, the Rohingya from northern Rakhine say Myanmar medical workers at government hospitals discriminate against them. And they said they face severe restrictions on movement when traveling to health care centers. Lewa pointed to Myanmar's Maungdaw District, where the army carried out what it called "clearance operations" after deadly militant attacks last year. Health centers set up by international non-governmental organizations in Maungdaw have been burned to the ground, Lewa said. She added that this will make it even more difficult for the Rohingya Muslims if and when they are allowed to return." Currently, international non-governmental organizations are not permitted to operate in the areas outside Maungdaw. Doctors Without Borders has reacted to the spread of diphtheria in Bangladesh by building treatment centers at the Balukhali refugee camp. Nolan said doctors are concerned about public health at the camp. Now, those who have come in contact with the bacterium must get antibiotics and other drugs to prevent the further spread of the disease and kill it. "We need to find all the suspected cases in the camps and get them all here to start the antibiotic treatment and keep them isolated for 48 hours," said doctor Thomas Hansen. Because the disease spreads easily, medical workers must quarantine the sick and then visit the patient's family to know if they also have the disease. Doctors Without Borders and its health partners are working together to find and quarantine suspected cases. One of the biggest problems for health workers is getting to rural areas where the disease can spread. With the arrival of the 650,000 refugees, new camp housing is being built well beyond the main roadways. "They live in areas that are difficult to reach," said Dagne Hordvei, team leader with the Norwegian Red Cross. "We have an agreement with [Doctors Without Borders] that we take the measles patients from them, and they take the diphtheria patients, with lots of activity going out to the communities to try to reduce the speed of the spreading of diphtheria." As Bangladesh's Ministry of Health and Family Welfare launches a vaccination campaign to prevent diphtheria, it appears that at least some of the young Rohingya will have protection from preventable diseases. As of December 21, Doctors Without Borders has observed more than 2,000 diphtheria cases in its health centers, and the number is rising. Most of the patients are between the ages of 5 and 14 years old. More than 20 Rohingya in Bangladesh have died from the disease. I'm Susan Shand. _______________________________________________________________