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Rohingya crisis: Five challenges we've faced delivering one million consultations
From maternity care to mental health, there are challenges still to overcome
In August 2017, a violent crackdown by authorities in Myanmar forced more than 700,000 minority Rohingya people to seek safety in neighbouring Bangladesh - joining over 200,000 refugees who had already fled the country.
Today, nearly one million Rohingya refugees are living in camps and makeshift settlements across Bangladesh's Cox's Bazar peninsular.
By December 2018, MSF had provided more than one million consultations to refugees and the local community, in response to the ongoing crisis. MSF medical coordinator Jessica Patti describes what our teams have learned.
1 - Most diseases are linked to poor living conditions
Almost nine percent (92,766) of our 1.05 million consultations were for acute watery diarrhoea, most cases in children under five, who are particularly vulnerable and can die if left untreated.
Diarrhoea is directly related to poor and overcrowded living conditions in the camps. However, clean drinking water and well-maintained latrines are key factors in preventing the illness, combined with health promotion activities to improve hygiene.
Poor conditions are also behind all the other main diseases we treat - including respiratory tract infections, skin diseases and fevers.
Simple hand washing with soap could prevent many of the skin conditions we treat. But, when you live in a refugee settlement, where clean water is scarce, washing your hands is not simple.
That’s why water and sanitation activities have been such an important part of MSF’s work. So far, our teams have distributed 87.8 million litres of clean water in the camps.
2. Despite vaccination campaigns, there is still a risk of disease outbreaks
In the early months of the emergency, we responded to various outbreaks of disease. This was caused by the limited healthcare available to Rohingya people while living Myanmar, leaving many without immunisations.
A quick response to outbreaks of diphtheria and measles was crucial, while further vaccination campaigns - including for cholera - have since been carried out. Our teams have now treated 6,547 people for diphtheria and 4,885 people for measles.
Controlling a diphtheria outbreak was particularly challenging, as occurrences are rare and most medical staff had not treated the disease before.
People in the camps are now better protected and our teams continue routine vaccinations. However, risks still exist. We have recently treated several hundred cases of chicken pox, a disease that is uncommon in South Asia and can have complications for pregnant women and people who are already ill.
3. Mental health services are vital in an uncertain future
Most of the Rohingya have experienced traumatic events. Many have suffered or witnessed violence and lost close relatives and friends. Many are unable to return home. This has caused many to suffer from depression and anxiety disorders.
Since the very beginning of the crisis, providing mental healthcare has been a priority - representing 4.7 percent (49,401) of our total consultations so far.
Our teams provide individual and group sessions, psychosocial stimulation for malnourished children, and treat people for psychiatric conditions. A good rate of our patients are discharged with improved mental health.
However, one challenge is that mental health services are unfamiliar to many Rohingya people, and are sometimes stigmatised. So, our teams continue to raise awareness of the care available.
4. Needs are not being met for chronic conditions and maternity care
Chronic diseases, such as diabetes and high blood pressure, are common amongst our patients, particularly the elderly. However, this is a significant need that is not being properly met.
We stabilise patients who need urgent treatment for chronic conditions, before referring them to organisations that provide longer-term care.
When it comes to childbirth, our teams have assisted just 2,192 deliveries - a low figure compared to other humanitarian environments we work in. This is because most women choose to give birth at home, as they did in Myanmar - a dangerous situation given conditions in the camp.
Those women who are then admitted to hospital often arrive late and can be suffering from complications such as pre-eclampsia, eclampsia, prolonged labours and retained placentas. Meanwhile, antenatal consultations made up just 3.36 percent (35,392) of total consultations.
5. An emergency situation is now a protracted crisis
At the start of our emergency response, we treated people for violence-related injuries suffered in Myanmar and basic healthcare was much needed. Today, we are treating patients for violence suffered in the community, or from sexual or gender-based violence - which remains an important focus for MSF.
The is now a major need for secondary healthcare, including treatment for non-communicable diseases.
MSF’s continued presence in Cox’s Bazar is also leading to an increase in consultations for members of the local Bangladeshi community, particularly in health facilities that are not located in the middle of the camps.