New influx of Rohingya refugees into Bangladesh pushes aid actors to the limit

CRISIS INFO #2

14 October 2017

SUMMARY OF MSF OPERATIONS IN COX’S BAZAR  

Number of projects: 7

Number of staff: around 1,000

Number of patients since August 25: more than 30,000

Main morbidities: respiratory infections, skin diseases and diarrheal diseases

Other activities: water trucking, pumps, tube wells, emergency sanitation and mental health support

Since August 25, MSF has treated more than 30,000 patients in the Cox’s Bazar area, effectively five times the number of people who sought treatment at MSF facilities during the same period last year. The main problem among these patients is respiratory tract infections and diarrheal diseases, which are directly related to the poor hygiene conditions in the informal settlements.

As a result of the massive increase in demand for our medical services, MSF has hired an additional 800 staff, bringing the total number of staff on the ground in Cox’s Bazar from around 200 people to 1,000. In July, MSF was treating approximately 200 patients a day, now MSF is treating over 2000 patients every day spread out over all clinics.

MSF has rapidly expanded its inpatient capacity at its Kutupalong medical facility from 50 to 70 beds, with new wards and isolation capacity for infectious diseases. The inpatient health facility, which provides basic primary and secondary healthcare services and is MSF’s largest health facility in Cox’s Bazar, has been running since 2009.  A second in-patient facility is under construction in Balukhali and is expected to open in mid-October with a focus on mother and child health. Two more in-patient facilities are also planned to open in the region to meet the increased demand for secondary healthcare.

But with a population of more than 521,000 refugees on top of the existing 200,000 who arrived previously, there is still a need to substantially increase the inpatient capacity. The challenge is to find the available space to setup Internally Displaced People (IDPs) as the area is severely congested.

Due to the huge pressure on our outpatient services with an approximately 2,500 Out Patient Department (OPD) consultations and 1,000 Emergency Room (ER) consultations per week at the Kutupalong clinic, demonstrating quadruple the demand since the influx, we are also setting up health posts (Balukhali, Mainnerghona) and additional mobile clinics to meet the needs of the new arrivals.  

WATER AND SANITATION WORKS (WASH)

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 200 latrines, 25 boreholes and a gravity water supply system while trucking an average of 100m3 water daily to the settlements from the MSF inpatient health facility borehole. Latrine and water point construction is planned in the worst affected areas, in coordination with the DPHE and other actors.

Between now and the end of December we aim to install an additional 100 deep tube wells, 300 shallow tube wells and 1000 latrines in the Balukhali and Kutupalong Makeshift Settlements. Given the size of the population (Kutapalong/Balukhali), we need to have 8,000 latrines built—that is a ratio of one latrine to 50 people for the emergency phase. The longer we delay that, the greater the risk of an outbreak of a waterborne disease. In the other locations, MSF is also assessing how to improve water and sanitation.

MSF PROJECT LOCATIONS IN COX’S BAZAR  

Mainnerghona Makeshift Settlement

A health post was set up on October 1 and is now expanded into an outpatient clinic. We have a system of ambulances to be able to refer patients needing urgent inpatient care to hospital. ​
Burma Para Makeshift settlement

A Surveillance Network and an OPD is being setup. The construction started on October 12 and we plan to start activities on October 1

IPD Health Centre

Land has been found to build a hospital. The plan is to build a temporary structure with a 30 or 50 bed capacity pending the construction of a sustainable IPD.

Jamtoli Makeshift Settlement

A health post has been running since late September with plans to expand to an OPD with additional services including a delivery room and examination beds and to set two mobile clinics in the periphery.

Hakimpara Makeshift settlement  

A new mobile clinic at the Hakimpara Settlement started running on October 8 with plans to setup one OPD in the entry of the camp and put in place two mobile clinics in total in the surrounding area.

Unchiparang Makeshift settlement  

An OPD with plans to expand to additional services with delivery room and examination beds and a mobile clinic in the periphery of the Settlement.

Hajjakahli Reception Centre  

A mobile clinic started activities on 8 October with nutritional screening and basic primary health care & monitoring at the border point. 

Baggoha/Putibunia Makeshift Settlement  

A mobile clinic started in later September and has been since upgraded to a health post. The clinic sees 160 patients per day on average.

Balukhali Makeshift Settlements  

A recently constructed 30 – 50 bed inpatient department (IPD) will be opened in the coming weeks. We have constructed an OPD during the influx in October 2016 and has seen triple the number of consultations since the 25 August influx. MSF has also opened one new Health Post in the part of the Settlement where new arrivals have settled. Two more health posts are planned in the coming weeks.

Kutupalong Makeshift settlements  

This medical facility maintains 70 beds and is currently the largest MSF health facility in Cox’s Bazar –running since 2009. Our services include outpatient consultations; a 24-hour emergency room; inpatient department with 4 wards for neonatal care, children and adults; basic laboratory services; sexual and reproductive healthcare services; and a Mental Health Department. The facility collaborates with local health authorities (who are able to use the MSF laboratory for testing for cholera) and local NGOs (providing care for TB patients). Since August 25, one new health post nearby has been opened and two more are planned in the coming weeks while the OPD will be moved further down the road to enable further expansion.

Other Activities

MSF plans to open additional mobile clinics and Health Posts to serve the people living in Hakimpara Makeshift Settlement. MSF is also supporting the Ministry of Health in its Cholera Vaccination Campaign with technical advice and community mobilization and logistical support. MSF is positioning emergency preparedness stocks and isolation sites (CTUs) in all operational areas in case of an outbreak or other critical health event affecting the population.

KEY MESSAGES  

Main Messages Myanmar

1. 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.
2. 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 organisations, 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 organisations only. Not only are the needs higher than the capacity of said organisation, but furthermore MSF is urging unfettered access Rakhine State to ensure the impartial delivery of aid to those in need
3. MSF is against the Government of Myanmar establishing camps for 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.

Main Messages Bangladesh

1. Over 536,000 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.
2. 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.