ROHINGYA: Diphtheria outbreak puts refugees in more peril

The peril of a public health emergency for Rohingya refugees in Bangladesh looms on the eve of 2018.

Diphtheria, a deadly disease long forgotten in most parts of the world thanks to increasing rates of vaccination, is now reemerging in Bangladesh among 655,000 Rohingya have taken refuge since 25 August following the horrific violence in Myanmar.

Since 21 December, Doctors Without Borders (MSF) has seen more than 2,000 suspected cases in its health facilities and the number continues to rise each day. The majority of patients are between 5 and 14 years old.

Diphtheria is a contagious bacterial infection that often causes the buildup of sticky grey-white membrane in the throat or nose. It is transmitted by droplets and spreads easily in the refugee settlements where people live in overcrowded conditions.

The infection is known to cause airway obstruction and toxins that damage to the heart and nervous system.  The fatality rate increases without the diphtheria anti-toxin (DAT). With global shortages of DAT and the limited quantity that arrived in Bangladesh. As of today there are only less than 5,000 vials of DAT globally.

If a patient doesn’t receive DAT early on in the progression of their illness, the toxin remains circulating in the body. This can cause damage to the nervous, cardiac and renal system weeks after the initial recovery period.

 “There is not enough of the medication to treat all of the people in front of you who need it and we are forced to make extremely difficult decisions,” says Crystal VanLeeuwen, the MSF Emergency Medical Coordinator for Bangladesh.  “It becomes an ethical and equity question.”

The emergence and the spread of diphtheria show how vulnerable Rohingya refugees are. The majority of the Rohingya are not vaccinated against any diseases, as they had very limited access to routine healthcare including vaccinations back in Myanmar.

“I have never seen so much suffering in my entire life. The Rohingya people are suffering. This is real. We saw patients coming in critical condition, some with complications, distressed and in shock. We saw them coming empty-handed, having lost everything in Myanmar,” recently returned MSF Southern Africa nurse, Dodo Kibasomba, says.

MSF has responded to the rapid spread of diphtheria by converting existing facilities, including important in-patient facilities into a diphtheria isolation and treatment centres. However, this causes a dilemma for MSF medical teams.

“Even before the diphtheria, there was a severe lack of inpatient bed capacity. Now we have had to convert those scarcely available beds to be dedicated treatment and isolation areas for diphtheria patients only. The women and children who previously had access to the facility no longer have this as an option. This is also creating a strain on the space and staffing available in non-diphtheria in-patient facilities which have taken on these patients. The teams have been adapting to the rapidly changing situation but we all face new challenges each day,” VanLeeuwen explains.

To contain the spread of the diseases, mass vaccinations to reach sufficient levels of coverage in the shortest possible time is vital. Ministry of Health and Family Welfare with the support of other actors have just started a mass vaccination campaign and MSF has been supporting this by setting up fixed points in our health posts.


  • An update on the diphtheria outbreak in the Rohingya refugee settlements in the Cox’s Bazar area of Bangladesh. Read it here
  • An article about MSF Southern Africa Nurse Dodo Kibasomba, who returned from working in the refugee settlements in Bangladesh. Find it here on an unpublished link on
  • An comprehenisve update on MSF operations in Bangladesh in response to the Rohingya Refugee Emergency  (Pdf file attached to this email). Also read it here





Doctors Without Borders/MSF is an independent international medical humanitarian organisation working to bring emergency medical care to people caught in conflict, crises and disasters in more than 65 countries around the world including South Africa. We rely on the regular generous donations from individual donors to support our work.

To support MSF’s medical work:  SMS “JOIN” to 41486 to donate R15 per month | visit


Contact us
Borrie la Grange Head of Communications, Doctors Without Borders (MSF) Southern Africa
Borrie la Grange Head of Communications, Doctors Without Borders (MSF) Southern Africa
About Doctors Without Borders (MSF) Southern Africa

Doctors Without Borders (MSF) Southern Africa
70 Fox Street, 7th Floor

South Africa