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Rohingya Refugees & Covid-19 ROHINGYA REFUGEES & COVID-19: Facing the Pandemic in the World’s Most Densely Populated Refugee Camps June 2020 ABOUT MEDGLOBAL MedGlobal is a humanitarian non-governmental organization working to serve communities by providing sustainable, innovative, and free health- care services to refugees, displaced people, and vulnerable populations in crisis-affected areas and low resource settings. Launched in 2017, MedG- lobal was established by a diverse group of doctors, nurses, and medics- experienced in humanitarian medicine and emergency services to address the health needs of the most vulnerable across the world. We work in humanitarian emergencies with a focus on collaborations with local health organizations, capacity building for local health professionals, and providing humanitarian and medical assistance. MedGlobal aims to create a world without healthcare disparity. MedGlobal currently supports sustainable operations and local healthcare in Bangladesh, Colombia, Yemen, and Greece, as well as leading humanitar- ian responses in Gaza, Syria, and Pakistan. MedGlobal has also supported medical assistance programs in Mexico, Puerto Rico, Venezuela, Lebanon, Jordan, Sierra Leone, Turkey, Kurdistan region of Iraq, and more, altogether organizing 188 volunteer medical missions to 14 countries around the globe. ACKNOWLEDGEMENTS Numerous MedGlobal staff, volunteers, and local partners contributed to this report through their expertise and information sharing. We particularly want to thank Dr. Rahana Parvin, MedGlobal Clinic Coordinator; Dr. Maryam Molla, former MedGlobal Field Coordinator; and Commander (Ret.) Ferdous Muhammed for their contributions to this report and outstanding dedication to supporting the healthcare of those in need in Cox’s Bazar. We want to thank the Health Sector, of which we are proud to be a member, particularly as they play a critical leading role in coordinating the COVID-19 response and sharing critical information. This report was co-written by Emma Forte Sczudlo, MedGlobal Missions Coordinator, and Kathleen Fallon, MedGlobal Advocacy Advisor. We want to give special thanks and appreciation to our local partners on the ground, particularly OBAT Helpers, with whom we are humbled and proud to partner for the health and wellbeing of Rohingya refugees and host communities. We give special thanks to all of our donors, especially the Latter Day Saints Charities who have supported our programs to pro- vide health care to Rohingya refugees. We thank the Bangladeshi people and government for opening their border and homes to nearly 1 million Rohingya refugees, in spite of limited resources, and encourage all govern- ments to follow their lead. We want to dedicate this report to the more than 860,000 Rohingya refugees in the Cox’s Bazar refugee camps, most of whom have survived atrocities in Myanmar and continue to face extreme hardships as refu- gees, the latest of which is the COVID-19 pandemic. 3 TABLE OF CONTENTS 06 EXECUTIVE SUMMARY 07 BACKGROUND 08 SITUATION DURING COVID-19 11 MEDGLOBAL’S HEALTH WORK WITH ROHINGYA REFUGEES 12 MEDGLOBAL’S COVID-19 RESPONSE FOR ROHINGYA REFUGEES 13 METHODS 14 KEY CONSIDERATIONS FOR THE COVID-19 RESPONSE 16 KEY NEEDS 17 RECOMMENDATIONS 5 5 EXECUTIVE SUMMARY BACKGROUND As COVID-19 spreads worldwide, it has the most dire im- • Scale up the COVID-19 prevention and response work. pact on vulnerable communities. The camps in Cox’s Bazar, • Maintain core health services. Bangladesh have the highest concentration of refugees in • Promote a needs-based reassignment of health workers. the world, with over 860,000 Rohingya refugees. The living • Adapt services to use alternate modalities for care. conditions in these camps are grim, with a high population • Adjust standard clinic operations such as facility mapping for Over 860,000 Rohingya refugees Cox’s Bazar has among Average population density: density, poor sanitation facilities and water quality, and lack social distance. in Cox’s Bazar3 highest concentration 103,600 Rohingya refugees of medical facilities. Even before the COVID-19 pandemic, • Prioritize protection of the most vulnerable. 4 5 Rohingya refugees faced an ongoing health crisis. • Expand mental health programming. of refugees in the world per square mile • Ensure local knowledge and religious beliefs inform the 4/4/2020 Map ROHINGYA REFUGEE RESPONSE/BANGLADESH The Rohingya, a largely Muslim ethnic minority, have Now, we are seeing the beginning of a much-feared COVID-19 response. Refugee Population by Location (as of April 30, 2020) faced decades of statelessness, discrimination, and COVID-19 outbreak in the Rohingya refugee camps. On • Work to increase community confidence in health services. violence in Myanmar. Before recent waves of dis- May 14, the first cases of COVID-19 were confirmed inside the • Scale up community-based surveillance. 860,175 placement, an estimated 1 million Rohingya lived camps. On May 31, an elderly Rohingya man became the first in Myanmar, primarily in its western Rakhine State.6 person to die from COVID-19 in the refugee camps while he For governments, including donor governments and the Bangla- 16,713 Rohingya families in Myanmar faced numerous bar- was undergoing treatment in an isolation center. 1 With the se- desh host government, we put forth the following riers to accessing healthcare - a lack of health work- vere overcrowding in the camps, there are widespread fears recommendations: 581,482 ers, badly maintained roads, poorly equipped and that COVID-19 will spread at an alarming rate. • Allow full access for humanitarians and health workers into the staffed hospitals, restrictions on movement, and dis- camps. criminatory practices in hospitals, such as segregat- • 40 confirmed cases among Rohingya refugees in the • Improve internet connectivity in the camps. 102,382 ed hospital wards.7 In August 2017, a renewed cam- camps • Improve information sharing processes related to COVID-19 paign of ethnic cleansing and atrocities against the with Rohingya refugees. 16,468 Rohingya in Myanmar began, which the UN Indepen- • 1,732 confirmed cases among Cox’s Bazar host • Maintain funding for core health services. dent International Fact-Finding Mission on Myanmar community members • Allow flexible funding. 10,494 concluded to be crimes against humanity and other • Reiterate that there should be no forced return of refugees. grave human rights violations.8 This not only led to • 436 tests conducted for Rohingya refugees (4.1% of total 21,206 widespread death and suffering, but also to the fast- tests in Cox’s Bazar district)2 Rohingya refugees have faced ethnic cleansing, forced displace- est refugee influx from Myanmar to Bangladesh, with ment, and overcrowded conditions in the world’s largest refugee almost 700,000 Rohingya fleeing to Bangladesh in MedGlobal has been working in Cox’s Bazar since 2017, serv- settlement. Now, they face a COVID-19 outbreak. An immediate less than a year. ing more than 112,300 Rohingya refugees and vulnerable and comprehensive response is needed from the internation- members of the Bangladesh host community with health care. al community to stop preventable deaths. These communities 26,026 Now, there are over 860,000 Rohingya refugees in At the onset of the COVID-19 pandemic, MedGlobal prepared must not be forgotten. the formal and informal camps around Cox’s Ba- a needs assessment for our field team in Cox’s Bazar related 7,403 zar, including over 625,000 crowded in the Kut- to key needs for COVID-19 preparedness and response. upalong-Balukhali Expansion Site. Cox’s Bazar was 40,440 22,640 already one of Bangladesh’s poorest districts, and Based on these needs assessments and information com- the addition of hundreds of thousands of refugees ing from the Health Sector, this reportexplores key consid- 14,921 has created a further strain on the host community. erations for the COVID-19 response for Rohingya refugees, There are 34 camps and settlements across Cox’s outlines a table of key needs (found on page 14), and puts Bazar district. forth recommendations. Creation Date: 30 April 2020 Source: GoB - UNHCR Joint Registration Exercise 1/1 Key local considerations are critical to inform the COVID-19 The living conditions in these refugee camps are dire, with poor sanitation facilities and a shortage of soap, extreme over- crisis response, and include Rohingya local knowledge and crowding, poor water quality, and lack of medical facilities. Tents and houses are often built out of bamboo frames and plastic perceptions, the impact of scaling down other health services, tarps, with many built on slopes or flood-prone low-lying areas, and the camps are not adequately equipped to handle the Cox’s Bazar travel limitations, WiFi connectivity restrictions, summer monsoon and cyclone seasons. Poor water and sanitation in the camps, as well as the crowded condition, increase and monsoon season. We have identified several recommen- the likelihood of communicable and waterborne diseases spreading among refugee families. Comprehensive health care dations for how health focused NGOs and international was one of the greatest needs among refugees even before the COVID-19 pandemic. organizations should adapt during the COVID-19 crisis: 1 Al Jazeera. “First Rohingya refugee dies from coronavirus in Bangladesh.” June 17, 2020. 5 ACAPS. “COVID-19 Rohingya Response.” March 19, 2020. https://reliefweb.int/sites/reliefweb.int/files/resources/20200319_acaps_covid19_risk_report_rohingya_response. https://www.aljazeera.com/news/2020/06/rohingya-refugee-dies-coronavirus-bangladesh-camps200602095409310.html
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