Bangladesh: Update on MSF activities in Cox’s Bazar
Number of staff: More than 2,000 national and international staff as of the end of November
Number of patients: More than 200,000 patients have been treated at MSF outpatient facilities and 4,938 patients in inpatient facilities between the end of August and the end of December
Main morbidities: respiratory infections, diarrhoeal diseases, diphtheria
Other activities: water and sanitation (water trucking and hand pump, tube well and latrine installation) and mental health services
Since 25 August, we have massively scaled up our operations in Cox's Bazar, Bangladesh. We now manage 15 health posts, three primary health centres and five inpatient facilities. The main morbidities among our patients are respiratory tract infections and diarrhoeal diseases, which are directly related to the poor shelter, water and sanitation conditions in the settlements.
Current public health concerns
Measles: Between September and January, we saw 3,539 cases of measles across all the MSF health facilities. The epidemiological curve of measles is decreasing significantly.
Diphtheria: By 22 January, MSF had treated more than 4,371 cases of diphtheria.
Most cases are aged between five and 14 years. Diphtheria can result in a high case fatality rate without the antitoxin. MSF has been administering antitoxin to patients but it requires a number of skilled human resources. At Rubber Garden, a former transit centre for new arrivals, we’ve set up a diphtheria treatment centre. More than 1,000 patients have been admitted there since 26 December 2017. We’ve treated a total of 231 patients with (diphtheria antitoxin. Active case investigation continues throughout the settlements and contacts are treated prophylactically with antibiotics via the health facilities.
With the arrival of an international medical team from the UK and new treatment sites set up by other actors, the capacity of treating suspected diphtheria cases should increase, which should hopefully allow our teams to start using MSF inpatient facilities for other, much-needed medical care.
With the support of other actors, the Ministry of Health and Family Welfare has implemented a diphtheria vaccination campaign. MSF has supported this by setting up fixed points in our health posts.
While Balukhali inpatient department serves as a diphtheria treatment centre, other cases, including measles, are referred to an MSF inpatient department in Tasnimarkhola.
Outbreaks of vaccine-preventable diseases like these demonstrate just how little access the Rohingya population had to routine healthcare in Myanmar.
As part of our preparedness plans for potential outbreaks, MSF has identified sites for the diarrhoea treatment units in Balukhali, Hakimpara, Jamtoli, and Unchiprang. The site preparations are finished in Balukhali and ongoing in the other locations.
MSF project locations in Cox’s Bazar
Rubber Garden (new)
Rubber Garden, near Kutupalong makeshift settlement, was used as a transit centre for newly arrived refugees. In December, an increase of suspected diphtheria cases prompted us to open a dedicated treatment centre there. It has 48 beds for severe cases and 150 for patients moderately affected.
MSF’s health facility in is our biggest in Cox’s Bazar. More information about the services and health posts, please refer to our December Crisis Update.
A network of MSF outreach teams focuses on hygiene, health promotion and surveillance. The teams carry out active case finding and make referrals to health facilities for diagnosis and treatment. Other activities include defaulter tracing and mobilisation for vaccination. For the duration of the diphtheria outbreak, our teams in this area completed contact tracing, treatment and follow-up for the contacts of patients diagnosed with diphtheria.
An inpatient facility in Balukhali has served as a 75-bed diphtheria treatment centre since early December, leaving only the emergency room functional for other morbidities. On 12 January, the facility became a 45-bed mother and child healthcare facility again. Services include paediatric and neonatal care, an inpatient therapeutic feeding centre (35 beds), maternity (10 beds), emergency room and observation and a 30-bed isolation ward. We also run three health posts and an outpatient facility in the settlement to provide basic healthcare. Health posts are now used as fixed vaccination sites for the Expanded Programme on Immunisation
MSF outreach teams in Balukhali carry out the same work as those in Kutapalong (please see above).
Since 1 October, MSF has run a health post in Balukhali 2 providing basic primary health care. Newly arrived refugees are being settled in the zone named SS, which also includes Balukhali 1 and Balukali 2. On 18 November, MSF opened a health post in this zone, where staff treat an average of 170 patients per day.
Please refer to our December crisis update.
More than 19,500 refugees live in Unchiprang makeshift settlement. We run a primary health centre there, which was initially opened as health post in mid-September. It is the main healthcare provider in the settlement and the team carres out around 159 consultations per day. We’ve opened a second health post in Uchiprang and in nearby Nayapara and treat 200 cases per day in both.
Jamtoli makeshift settlement now hosts 50,500 refugees. The health post we opened in September was later upgraded to a primary healthcare centre. The clinic currently sees around 230 patients per day and offers a 24-hour primary healthcare service, with a delivery room and 18 hospitalisation beds and an ambulance referral system. Among the services are a 24-hour emergency room and observation, and an outpatient department that includes a paediatric ward, sexual reproductive healthcare and mental health services.
More than 32,000 refugees live in Hakimpara makeshift settlement. We run a primary healthcare centre with 24-hour services and 14 hospitalisation beds where we treat around 150 patients per day.
The centre offers a 24-hour emergency room and observation, an outpatient department, including a paediatric ward, sexual reproductive healthcare and mental health services.
MSF runs two other health posts in Hakimpara. They have suspended their daily operations and have been on standby since the diphtheria outbreak started due to staff detachments to the diphtheria treatment centre to support contact tracing and patient follow-up activities.
Moynarghona makeshift settlement hosts more than 19,500 refugees. The mobile clinic we started running in September has since been upgraded to health post. Our team carries out an average of nearly 160 consultations per day. The health post has an emergency room, an outpatient department, including a paediatric ward, and offers sexual reproductive healthcare and mental health services.
Diphtheria treatment centre
MSF planned to open a 63-bed inpatient department outside the mega-camp makeshift settlement before the end of the year.
When the diphtheria outbreak started, this site near Jamtoli and Moynarghona makeshift settlements was transformed into a diphtheria treatment centre. It has admitted severe and moderate cases since 11 December. The centre is also a referral point for all moderate and severe cases among the Rohingya population and host community from nearby camps and villages and the south (Unchiprang, Nayapara and Teknaf). Construction work on the inpatient structure is nearly finished.
When the diphtheria cases recede, the facility will include a 24-hour emergency room, an outpatient department, an inpatient department that will include a paediatric and neonatal ward, isolation beds, a diarrhoea treatment ward, sexual and reproductive healthcare services, a mental health department, a basic laboratory services and an ambulance referral system.
Sabrang entry point
At the border point in Sabrang, MSF started a mobile clinic in October, offering nutritional screening and basic primary health care and monitoring. These services are now integrated into the circuit of the reception centre. The daily mobile clinic sited in Sabrang entry point provides consultations to an average of 24 new arrivals per day. Mobile clinic services include adult and paediatric outpatient consultations, as well as the identification of severe cases and referrals.
We are supporting the government in expanding routine vaccination in the camps by initiating vaccination for children and pregnant women at our facilities. Staff at all MSF health facilities will have the capacity to administer immunisation for measles and rubella, oral polio and tetanus according to national protocols.
The Ministry of Health completed a measles and rubella vaccination campaign on 6 December. It targeted more than 336,000 children between the ages of six months and 15 years. MSF supported this campaign with community mobilisation, site identification, logistics, and the transportation of vaccines. In Kutapalong and Balukhali,, 156,679 and 41,066 people were vaccinated respectively.
- Total number of sexual violence cases from 25 August – 31 December: 120
- Number of rape cases: 101
- Number of SGBV cases under 18: 45
- Number of cases of male on male sexual violence: 0
For more information on our response to sexual violence, please refer to our December crisis update.
Water and Sanitation (WASH)
Beyond our medical response, improving water and sanitation is a major part of our work to prevent the spread of disease. Water sources are insufficient and often polluted with sewage, latrines are not deep enough and no provision has been made for a drainage system; and latrines and water sources are set up near to each other, easily resulting in contamination.
Read about our WASH activities in Cox’s Bazar in our December crisis info.