Claudio Miglietta, Bangladesh country director of Médecins Sans Frontières (MSF), recently spoke to Dhaka Tribune Staff Reporter Nawaz Farhin Antara about medical issues at the Rohingya camps, including mental health, trauma, violence, and the role of international communities.
MSF has been working for the displaced Rohingya and host community directly since 2009 and scaled up its activities in 2017 following the mass exodus that year. What issue at the camps are you most concerned about right now?
-MSF has been observing that the living conditions in the camp are deteriorating and people's medical needs are growing. We have observed repeated incidents of cyclones, floods and landslides that are causing the temporary shelters of the refugees to be destroyed. We have also seen frequent fire incidents in the camps. The flimsy materials that shelters are built with means that in the densely populated camps in Cox's Bazar, fire spreads rapidly, devastating the lives of many Rohingya refugees. We have directly experienced this; the flames of a massive fire that engulfed much of camp 9 in March 2021 completely destroyed our Balukhali clinic. In that fire, 15 people lost their lives and around 45,000 people were displaced within the camp.
Living in this congested and overcrowded area also means the quicker spread of contagious diseases, including skin and respiratory diseases. Scabies has been of particular concern, as we have done over 150,000 consultations since the outbreak began in March 2022, with every indication that it will continue unless more is done to address it. Despite receiving and treating 600-700 patients every day, still hundreds more patients visit us to seek treatment for scabies. We have reached our daily intake capacity and are redirecting patients to other facilities or requesting them to visit at any other moments as we are not able to receive more per day.
Regarding water and sanitation, although we have seen the quality of water within the camp has improved since 2018, unfortunately, people still do not have access to continuously available water to meet their needs. The sanitation and hygiene situation has deteriorated in the last three years, impacting refugees' ability to live in dignity. Organizations that used to provide water are now less in number than they used to be. While we have seen a considerable amount of wash infrastructure improvements, there is an extreme degradation in the maintenance of those infrastructures. There are fewer functioning latrines and as well as a lack of soap. In many places in the camps, people receive water for only two hours per day. These gaps in the provision of proper water, hygiene and sanitation facilities present an on-going, but amendable risk, to the health of refugees. We are collaboratively working with WASH sector partners and advocating with donors to improve the situation.
Mental health continues to be a significant concern in the Rohingyas community after they fled atrocities in Myanmar, witnessed first-hand trauma and violence. Do you work on the mental health of Rohingyas?
One of the main components of MSF's healthcare services in Bangladesh is mental health. Within the camps in Cox's Bazar, MSF has been running mental health activities since 2009. Our teams provide support through individual, family and group counselling sessions, where mental health specialists focus on coping mechanisms and building resilience.
In the Rohingya refugee camps, we have witnessed changes in the trend of mental health issues. We are still hearing vivid memories of difficult times and flashbacks of the traumatic events from our patients. People tell us about the challenges of their present living conditions and the uncertainty about their future as well. People feel they are in limbo, which makes them really frustrated because they do not see any future for themselves, and sadly for their children either. Our team is seeing extreme hopelessness among refugees, which can result in depression, and complex psychiatric problems relating to people's lack of choice and lack of freedom. They have also expressed concern over the lack of access to adequate healthcare in the camps, specifically mentioning NCD treatment, among others. From January to December last year, our teams in Cox's Bazar have provided 31,906 individual mental health consultations and 21,874 group consultations.
What are the challenges in regard to physical health in camps?
Since 2017, Rohingya refugees have been living in “temporary” shelters in camps in Cox's Bazar, where living conditions are congested and unsanitary. Our teams are seeing and our patients are telling us about the health impacts of living in conditions like this.
MSF witnesses and is responding to the medical consequences of poor camp conditions among the refugees. Particularly, we are seeing an increased number of patients in our facilities in need of care for skin disease. The number of people suffering from scabies is the highest we have seen in last three years. Our teams have treated an average of 43,000 patients with skin diseases in 2019 and 2020. This number has jumped to 73,000 patients suffering from skin diseases in 2021. In 2022, from August to December, our teams treated 127,251 patients with skin diseases. We are also seeing patients suffering from chronic illnesses like diabetes and hypertension. The numbers are high among both refugees and the host community. Our teams have provided 63,316 consultations for non-communicable diseases in 2022.
It has been five years and repatriation has not yet taken place despite repeated attempts. Do you think voluntary repatriation of Rohingyas to Myanmar, with dignity and safety, can ever take place?
Many of our patients have indicated the desire to return to Myanmar, as they identify with it as their homeland. However, they are also stressed and want to be assured that if they do so, they will be safe and have rights. Some of them expressed the fear that they would be subjected to persecution or torture upon their return without guarantee of their safety. MSF stands in solidarity with the Rohingya communities we support, not only in Bangladesh, but those in Malaysia and those who remain in Myanmar. We support their desire to live in safety, and to live a dignified and humane life where all their rights are assured. Bangladesh is to be commended for hosting this persecuted population. But regional countries must do more to find a long term solution to the crisis. As MSF, we are giving visibility to the issue and calling for the attention of regional and humanitarian communities to this regional refugee crisis which requires a regional solution.
Like many other development organizations, has MSF been seeing a funding crunch right now? If yes, how is it affecting its humanitarian work in Bangladesh?
-MSF does not rely on donor funding. Our funding relies largely on individuals donating small amounts. This helps to ensure our operational independence and flexibility to respond at a moment's notice to the most urgent crises, including those which are under-reported or neglected. MSF's unique model of financial independence allows us to provide support where humanitarian needs are the most urgent, independent of the priorities or agendas of any states or other organizations. However, MSF is also faced with conflicting humanitarian priorities that are putting a strain on resources. This is why we cannot help everywhere. That's why MSF remains committed to supporting the Rohingya in Bangladesh and across the region. We plan to maintain the same level of medical humanitarian activities in 2023.
Media reports suggest that HIV is making a comeback in Cox's Bazar, both among Rohingyas and the host community. How do you assess the situation?
- MSF doesn't have a dedicated HIV project in Bangladesh. As per protocol, the Ministry of Health are responsible for the care of HIV patients in Bangladesh. To have detailed information, please check with the Ministry of health.
Tell us something about your programme at Kamrangirchar in Dhaka, where you assist survivors of sexual and gender-based violence.
We have been present in the Kamrangirchar area of Dhaka since 2013, where we provide medical treatment for 7,000 workers at small-scale factories. Our sexual and gender-based violence services include treatment for injuries, vaccinations, measures to prevent sexually transmitted diseases, and mental health support. We also have a dedicated hotline number for sexual and gender-based violence survivors, where they can call 24/7 and ask for support from our counsellors. In 2022, our team in Kamrangirchar had 1699 sexual and gender-based violence consultations. Our team also provides reproductive healthcare to adolescent girls, by carrying out antenatal consultations and assisting deliveries. In addition, MSF offers family planning sessions and individual mental health consultations.
