Bangladesh

• People in need: 1.5 million¹
• People targeted: 1.5 million
• People in need of health assistance: 1.4 million
• Requirements (US$): 12.2 million

Context

In the fifth year since the largest influx into Cox’s Bazar, close to 1 million Rohingya refugees (Forcibly Displaced Myanmar Nationals (FDMN)) now reside in one of the world’s largest refugee camps in Ukhiya and Teknaf Upazilas. There are approximately an additional 540 000 Bangladeshi nationals living in the two Upazilas, bringing the total population in the two Upazilas to 1.44 million people who require humanitarian support. While there have been various efforts to address the living conditions in these densely populated camps, the overcrowding continues to expose them to significant public health risks, greatly impacting health care services in the camps and surrounding host communities. WHO continues to coordinate over 70 health sector partners who operate in over 140 health care facilities in the 33 camps in the two Upazilas. WHO supports the Ministry of Health and Family Welfare (MoHFW) with the mandate and capacity to set priorities, minimum standards and support quality health service delivery.

As of August 2022, COVID-19 vaccination coverage for both refugee and host populations in the refugee camps was 83% for persons 18 years and older and children aged 12-17 years. Other disease outbreaks, however, continue to be registered in the camps due to the challenging living conditions and low levels of immunity. Thus, the risk of impending outbreaks in these endemic and conducive settings remains high. This includes cases of scabies which have recently been brought under control; dengue fever with high transmission rates; diphtheria (there have been a total of 251 cases since December 2017 as of 2022, with gaps in the supply of diphtheria antitoxin and PCR testing kits) and cholera, despite several vaccination campaigns. However, mortality rates have been kept to a low level or zero.

Emergency response

WHO has been supporting the Government of Bangladesh to respond to the COVID-19 outbreak through a well-established pillar response system in line with national and global structures, while continuing to deliver an effective health response to Rohingya refugees. This is being undertaken through increased investment in public and local institutions and capacity development of local authorities, in addition to that of partners.

WHO’s response strategy for 2022 and beyond will follow this approach. The strategy is aligned with the overall Health Sector Strategy 2023-2024 and aims to address key response areas based on health sector priorities highlighted by the Strategic Advisory Group and the Joint Response Plan 2022. These are based on multisectoral needs assessments, a comprehensive gender analysis of Rohingya refugees and host communities in Cox’s Bazar (as of March 2022), and the WHO Health Resources Availability and Monitoring System (HeRAMS) 2022, an electronic system for assessing the availability of medical services. Based on changing needs, the preparedness and response plans will be revised and updated.

Key focus areas, in collaboration with the water, sanitation and hygiene (WASH) and site management sectors, include the containment of persistent acute watery diarrhea (AWD), and cholera and dengue fever transmissions and outbreaks. WHO will also continue to coordinate the health sector and protect refugees from COVID-19, monitor essential health service delivery in camps and host communities, and contribute to streamlining efforts in the camps. This will ensure the sustainability of interventions and benefit Rohingya refugees and host communities, while contributing to building resilient systems for future unforeseen events and emergencies.

In addition, WHO will continue to train government personnel and health care workers from partner organizations on a range of health topics, including surveillance, laboratory diagnostics and case management for neglected tropical diseases, and will continue to conduct risk assessments and reviews of response interventions.

Furthermore, WHO will continue to monitor reporting of data collection and monitoring tools; disseminate information products, and conduct training to improve the quality of information shared with partners. This will include ensuring that a robust system for prevention, early detection and response to outbreak-prone diseases, through Early Warning, Alert and Response System (EWARS), and community-based surveillance, is being maintained and strengthened. EWARS is an electronic system for effective disease surveillance to detect disease outbreaks quickly before they spread, cost lives and become difficult to control.

Strategic objectives

Key activities

• Support preparedness and the response to infectious pandemic and epidemic-prone diseases (e.g., cholera, dengue fever, diphtheria and COVID-19) for Rohingya refugees and the surrounding host population
• Strengthen surveillance systems, including sentinel surveillance
• Integrate Influenza Like Illness (ILI) into Severe Acute Respiratory Infections (SARI) surveillance
• Strengthen contact tracing for diphtheria and COVID-19 response
• Support the procurement of rapid diagnostic tests (RDT) test kits for dengue fever and diphtheria
• Support the sustaining and scaling up of epidemiological surveillance and response activities and trigger a response for other prioritized epidemic-prone infectious diseases within the camps and the surrounding host population
• Focus on capacity-building of health care workers and develop surveillance protocols and standard operating procedure to guide readiness and response plans, through needs-assessment informed training and monitoring supervision to ensure quality implementation

Funding requirements

Overall country funding requirements, including COVID-19, by pillar (US$’000)

Success stories

WHO's early warning system integrates with Bangladesh’s national reporting platform

Areas that are most in need of an early warning system are often the hardest to reach. EWARS is the perfect solution, offering a simple way to track and report emerging threats.

As an early response to the Rohingya crisis, WHO implemented the EWARS-in-a-box system, which is a single solution for complex monitoring needs. This system gave health workers the ability to report emerging threats instantly, with the data then being transferred back to a dashboard for internal and external stakeholders.

In partnership with the Government of Bangladesh and UNICEF, WHO led the integration of EWARS with the District Health Information Software (DHIS2) platform. DHIS 2 is an open source, web-based platform most commonly used as a health management information system (HMIS). The integration ensures closer collaboration on disease prevention and detection. Government health specialists will have ongoing access to EWARS data, giving them a strong picture of the health situation in the Cox’s Bazar displacement camps.

“EWARS captures several critical dimensions of the health situation in Cox’s Bazar,” says Dr David Otieno, WHO Epidemiologist. “It measures the sensitivity of reporting tools, timeliness, flexibility and much more. Now it’s been integrated with EWARS, DHIS2 gives us a platform for closer collaboration with national partners. We’ll have more clarity regarding the relationship between health situations in the host community and camps. The Government will also have instant access to health information.” Dr Otieno adds.

WHO delivers essential action on scabies in the Rohingya displacement camps

In early 2022, health facilities in the Rohingya displacement camps began reporting an alarming increase in skin disease cases, particularly scabies. WHO acted immediately, and alongside partners completed a community mapping project that identified scabies as having crossed the 10% transmission threshold for mass drug administration intervention. WHO worked with partners to strengthen the management system, improve community awareness and ensure a quality WASH response. By June 2022, scabies cases had declined by 77%, with most camps showing transmission rates between 2% and 4%.

For more information

Dr. Bardan Jung Rana | WHO Representative | WHO Bangladesh | ranab@who.int

Dr. Jorge Martinez | Head of Sub Office | WHO Cox’s Bazar Emergency Sub Office | martinezj@who.int