Why are we there?
- Social violence/Healthcare exclusion
- Natural disaster
- Severe malnutrition
There are acute medical needs in Bangladesh, and Médecins Sans Frontières/Doctors Without Borders (MSF) is working in a range of contexts, treating people who would not otherwise have access to medical services.
In Cox’s Bazar, one of the poorest districts of Bangladesh, thousands of Rohingya who have fled Myanmar remain unregistered and are considered illegal immigrants. Many are living in and around the makeshift camp of Kutupalong.
In Kutupalong clinic, MSF treated over 55,000 patients in 2011, both Rohingya from the camp and local Bangladeshis. Staff provided basic outpatient and inpatient care, maternity services, family planning, vaccinations and mental healthcare.
The team carried out a nutritional survey and found high rates of malnutrition among the Rohingya.
From January to September, staff admitted 440 malnourished children suffering from medical complications to the clinic. In addition to medical activities, MSF lobbied for improved living conditions for the stateless Rohingya people.
In Fulbaria, north of the capital Dhaka, MSF runs a kala azar treatment centre with the Ministry of Health.
Kala azar (visceral leishmaniasis) is transmitted by a sandfly that lives in the cracks of mud houses. After malaria, it is the second-biggest parasitic killer worldwide. Women and children are particularly vulnerable to the disease, which, if left untreated, is fatal.
In 2011, MSF treated more than 1,700 patients for kala azar and related illnesses in Fulbaria using liposomal amphotericin B, the treatment it introduced in 2010. This drug is safer and more effective than earlier drugs, which were highly toxic and needed to be taken for longer.
Treatment time has been reduced to just three days over a five-day period, and patients no longer have to be hospitalised. In 2011, over 99 per cent of patients treated for kala azar by MSF were cured.
Despite a high prevalence of the disease in the area, not many people are aware of kala azar. An outreach team works in the community to identify patients with the disease and refer them for treatment.
The team teaches people about the symptoms of the disease and how it is transmitted, informs them about treatment options and carries out health education activities.
MSF also provides an extra level of quality control and supervision within the Ministry of Health vector control programme, reporting findings to the head of the kala azar elimination programme.
Healthcare in Dhaka
Dhaka, Bangladesh’s capital, is one of the most densely populated cities in the world. Thousands of informal settlements have sprung up as socioeconomic and environmental pressures bring people from rural areas to the city.
Most residents of these settlements lack access to good-quality health services. In Kamrangirchar, home to nearly 400,000 people, MSF runs two basic health centres offering free maternal and paediatric care, and focusing particularly on treating severe malnutrition.
Staff conducted approximately 28,000 consultations and admitted more than 900 children and 580 pregnant or breastfeeding women to the nutrition programme.
Many patients were suffering from diarrhoea and skin infections, often a direct result of poor water quality and unhygienic living conditions. MSF also responded to a measles outbreak in Kamrangirchar.
At the end of 2011, MSF had 323 staff in Bangladesh. MSF has been working in the country since 1985.
“My name is Salma. I live in Kamrangirchar together with my mother and my two small daughters. I have to work to support them all, because my husband left me for another woman.
"I work on a building site, where I carry bricks, bags of cement, climb stairs. The men there swear and threaten to hit me if I don’t work hard. It is very difficult for me, but I have to do it – where else will the money come from?
“Every few days, I suffer from pains, feel feverish, catch colds, and I also get sores and ulcers on my limbs. I was unable to produce breastmilk, and therefore my youngest baby became very thin and sick.
"Now MSF is looking after her in many ways, and makes sure she is properly nourished. They come and check up on the baby and also give me advice on how to cook good food. I am very happy for this.”