Bangladesh: Latest MSF Updates

October 2017: Doctors Without Borders/Médecins Sans Frontières (MSF) Operations Summary

Number of projects: 7

Number of staff: Around 1,000

Number of patients since August 25: More than 30,000

Main morbidities: Respiratory infections, skin diseases, and diarrheal diseases

Other activities: Water trucking, pumps, tube wells, emergency sanitation, and mental health support

As the influx of ethnic Rohingya refugees fleeing Myanmar continues, Doctors Without Borders/Médecins Sans Frontières (MSF) teams have treated more than 30,000 patients in the Cox’s Bazar area in Bangladesh, effectively five times the number treated at MSF facilities during the same period last year. The most common ailments are respiratory tract infections and diarrheal diseases, which are directly related to the poor hygiene conditions in the informal settlements.

MSF has hired an additional 800 staff members in response to the massive increase in demand for medical services, bringing the total number of staff on the ground in Cox’s Bazar from around 200 people to 1,000. In July 2017 MSF treated approximately 200 patients a day; now teams treat over 2,000 patients daily.

MSF has rapidly expanded inpatient capacity at its Kutupalong medical facility from 50 to 70 beds, with new wards and isolation capacity for infectious diseases. The inpatient health facility, which provides basic primary and secondary health care services and is MSF’s largest facility in Cox’s Bazar, has been operating since 2009.  A second inpatient facility is under construction in Balukhali and is expected to open in mid-October with a focus on mother and child health. Two more inpatient facilities are also planned to open in the region to meet the increasing demand for secondary health care.

But with a population of more than 521,000 newly arrived refugees in addition to the 200,000 Rohingya who arrived in Bangladesh previously, there is still a need to substantially increase the inpatient capacity. The challenge is to find the available space to set up inpatient departments, as the area is severely congested.

Due to the huge pressure on MSF’s outpatient services, with approximately 2,500 outpatient department (OPD) consultations and 1,000 emergency room (ER) consultations per week at the Kutupalong clinic, MSF is also setting up health posts at Balukhali and Mainnerghona and additional mobile clinics to meet the needs of the new arrivals.  

Water and Sanitation

In addition to the medical response, MSF is also working to improve water and sanitation services to prevent the spread of disease. MSF has built 200 latrines, 25 boreholes, and a gravity flow water supply system, while trucking an average of 100 cubic meters of water daily to the settlements from the borehole at the MSF inpatient health facility. Latrine and water point construction is planned in the worst-affected areas, in coordination with the Bangladeshi Department of Public Health Engineering and other actors.

Between now and the end of 2017 MSF aims to install an additional 100 deep tube wells, 300 shallow tube wells, and 1,000 latrines in the Balukhali and Kutupalong makeshift settlements. Given the size of the refugee populations in Kutapalong and Balukhali, 8,000 latrines must be built to meet a ratio of one per 50 people. MSF is also assessing ways to improve water and sanitation in other areas.

Timeline: Looking Back at the Rohingya Refugee Crisis

MSF Project Locations

Kutupalong Makeshift Settlements

This medical facility maintains 70 beds and is currently the largest MSF health facility in Cox’s Bazar. It has been running since 2009. Services include outpatient consultations; a 24-hour emergency room; an inpatient department with four wards for neonatal care, children, and adults; basic laboratory services; sexual and reproductive health care services; and a mental health department. The facility collaborates with local health authorities (who are able to use the MSF laboratory for testing for cholera) and local nongovernmental organizations (providing care for tuberculosis patients). Since August 25, one new health post nearby has been opened and two more are planned in the coming weeks. The OPD will be moved further down the road to enable further expansion.

Mainnerghona Makeshift Settlement

A health post was set up on October 1, 2017, and has now expanded into an outpatient clinic. A system of ambulances refers patients needing urgent inpatient care to the hospital.

Burma Para Makeshift Settlement

A health surveillance network and an OPD are being set up. Construction began on October 12 and activities are planned to begin on October 16.

Inpatient Department Health Center

A site has been identified on which to build a hospital. The plan is to build a temporary structure with 30- or 50- bed capacity, pending the construction of a sustainable IPD.

Jamtoli Makeshift Settlement

A health post has been running since late September with plans to expand to an OPD with additional services, including a delivery room, examination beds, and two mobile clinics on the periphery.

Hakimpara Makeshift Settlement

A new mobile clinic at the Hakimpara Settlement started running on October 8, with plans to set up one OPD at the entry of the camp and implement two mobile clinics in the surrounding area.

Unchiparang Makeshift Settlement

MSF runs an OPD with plans to expand to additional services with delivery room, examination beds, and a mobile clinic on the periphery of the settlement.

Hajjakahli Reception Center

A mobile clinic started on October 8, offering nutritional screening, basic primary health care, and monitoring at the border point. 

Baggoha/Putibunia Makeshift Settlement

A mobile clinic started in late September and has since been upgraded to a health post. The clinic sees 160 patients per day on average.

Balukhali Makeshift Settlements

A recently constructed 30- to 50-bed inpatient department will open in the coming weeks. MSF constructed an OPD during the influx of refugees in October 2016 and has seen triple the number of consultations since the August 25 influx. MSF has also opened one new health post in the area where new arrivals have settled. Two more health posts are planned to open in the coming weeks.

Other Activities

MSF plans to open additional mobile clinics and health posts to serve the people living in Hakimpara makeshift settlement, and is also supporting the Ministry of Health in its cholera vaccination campaign with technical advice and community mobilization and logistical support. MSF is  positioning emergency preparedness stocks and isolation sites (CTUs) in all operational areas in case of an outbreak or other critical health event affecting the population.

This information is excerpted from MSF’s 2016 International Activity Report.

MSF continued to provide health care to vulnerable people in Bangladesh, including large numbers of Rohingya refugees from Myanmar. MSF ran a clinic offering comprehensive medical care to Rohingya refugees and the local community near the Kutupalong makeshift camp in Cox’s Bazar district. There was a sharp increase in patient figures in the last two months of the year due to an influx of Rohingya fleeing Myanmar’s northern Rakhine state. The team treated 113 violence-related injuries in November and December, including 17 with gunshot wounds. During the year, teams carried out 89,954 outpatient, 2,491 inpatient, and 4,559 mental health consultations. They also treated 103 victims of sexual violence in 2016, more than double the number in 2015.

In Kamrangirchar slum, in the capital, Dhaka, MSF offered reproductive health care to adolescent girls, carrying out 4,578 antenatal consultations and assisting 457 deliveries in 2016. The team provided medical and psychological support to 535 victims of sexual violence and intimate partner violence. In addition, 2,324 family planning sessions and 2,379 individual mental health consultations were conducted with people of all ages. MSF continued to run its occupational health program for factory workers in Kamrangirchar, carrying out 8,923 consultations.

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