In Cox´s Bazar, where I work as the medical coordinator for medical humanitarian organization Médecins Sans Frontières/Doctors Without Borders (MSF), there are around 1 million refugees hosted in barely 26 square kilometres.
This makes physical distancing measures to help slow the spread of the Covid-19 pandemic, close to impossible. But in the fight against the Covid-19 pandemic, overcrowding is not the biggest challenge here: Stigma is.
The fear of Covid-19 is palpable and it will cost lives. People are afraid of Covid-19, and many are actively avoiding health facilities because they fear being stigmatized, evicted from their homes, or separated from their families.
In just the past two months, we have seen a dramatic reduction in consultation numbers across our facilities. So now, alongside medical care, we must also focus on empowering and mobilizing people so they feel safe to come into clinics to seek health care.
That’s because even in the shadow of this virus, other health needs remain.
Babies will continue being born, survivors of violence will continue needing mental health support, vaccination campaigns for other diseases will need to continue to prevent other deadly epidemics, and people will keep falling sick with other health conditions.
MSF has scaled up to respond to Covid-19 in our medical facilities across Bangladesh, in both Cox’s Bazar and Dhaka.
We have built new isolation wards in all our facilities in Cox’s Bazar and prepared two dedicated Covid-19 SARI ( severe acute respiratory infection) treatment centres -- one in Ukhiya and one in Teknaf, which will provide an estimated 260 additional beds for local Bangladeshi communities and Rohingya refugees.
We hope to open in the coming weeks, once we have sufficient staff and medical supplies. Increasing our response to this pandemic has meant a massive recruitment effort to hire skilled staff for our expanded medical response, and this is still ongoing.
While in Dhaka, we’ve focused resources on our main clinic in Kamrangirchar where we continue to provide reproductive health and sexual and gender-based violence services, and vaccinations, as well as community prevention of Covid-19, including health education for Covid-19, mask distribution, and support to testing services.
However, this pandemic sees MSF facing challenges that we’ve witnessed during other disease outbreaks around the world, but on a much larger scale. One of these is trust. People must trust that they will be safe if they seek medical care and that any medical treatment they receive will be respectful and humane.
Patients we have treated with Covid-19 have told us concerning stories of families being taken to quarantine centres against their will; threatened with eviction from their homes or being subjected to aggressive or threatening language.
If people experience dehumanizing behaviour or fear they will be separated from their families, they will understandably avoid seeking testing or treatment. This will only further feed stigma, fear, and further exacerbate the spread of the virus.
Covid-19 is a global challenge, affecting all people everywhere across the world. To tackle this, we must work together hand-in-hand to slow the spread of this virus. This means ensuring that people are able to access high-quality care, safely and with dignity.
People must be treated with respect. As Mohammad, an MSF Covid-19 patient who experienced stigma said: “If someone is Covid-19 positive, don’t look down on them, don’t harm them, and don’t threaten their family.
It is not their fault. If we can find a way to change people’s fear, then we can encourage them to come to the hospitals and stop spreading the virus.”
We must also hold onto hope, and celebrate each victory and each survival. Syeda, a mother from Ukhiya, knows this personally. She faced a nightmarish experience after both she and her newborn son contracted Covid-19.
They were referred to MSF’s Goyalmara mother and child hospital in Cox’s Bazar, where they received treatment in the SARI isolation ward. After several days of inpatient treatment, their symptoms started to ease.
“Now my baby is receiving oxygen, he’s improving,” Syeda said with obvious relief. “He is better than before.”
Dr Husni Mubarak is the MSF medical coordinator in Cox´s Bazar.