July 25, 2004
Some areas of the conflict-plagued Chittagong Hill Tracts in southeast Bangladesh are so remote they are only accessible by foot. MSF provides basic medical care in the area, with a focus on treating malaria.
Bangladesh is one of the most densely populated countries in the world, with 130 million inhabitants. By way of contrast, the Chittagong Hill Tracts are sparsely populated with people living in very remote areas. The region is mountainous, unlike the rest of Bangladesh, which is very flat.
MSF is working in the Chittagong Hill Tracts near the border with Myanmar (Burma) and India where MSF has two health center and several mobile clinics in the Khagrachari District.
Along with providing basic healthcare, MSF has started a second project in the Bandarban District based on the same principle. In addition, both projects focus on treating malaria.
"Unlike the rest of Bangladesh, the Chittagong Hill Tracts are hard hit by malaria-90 percent of the people suffering from malaria are living in this region, causing high morbidity and mortality amongst the population," said Annette Peters, who has been head of mission in Bangladesh for the past year.
"Our studies revealed that 40 percent of the patients were resistant to the drug chloroquine, which is still the first-line drug for treating patients with falciparum malaria in Bangladesh," said Peters. "Therefore, we lay great importance in achieving a change of the treatment protocol in Bangladesh. MSF is already treating its patients with the effective artemisinin-based combination therapy (ACT)."
In addition to fixed clinics, MSF teams often leave the beaten path in order to provide care in remote areas. However one aspect of the challenge is access. Some of the areas are so remote that even four-wheel drive vehicles are not an option.
"The team then needs to abandon the vehicle and ventures up into the mountains by foot," Peters said. "The hike usually takes one to two hours, but occasionally even as long as five. When the hike is very long, the team will remain in the village overnight in order to have enough time to treat the patients."
"Our aim is to reduce the mortality rate caused by malaria as well as to respond to outbreaks of infectious diseases. The challenge remains working in a crisis-hit area with a virtually non-existent infrastructure. We want to reach out to people in remote areas in order to provide them with good health-care services.
While Muslim Bengalis account for the majority of the population in Bangladesh, the Hill Tracts are inhabited by an additional 13 different minority groups with different religious beliefs. These people are of Burmese or Tibetan origin whose religious backgrounds are Buddhist, Hindu, Christian or animistic.
There is a great need for medical aid as there are no adequate public health-care services available, and few aid organizations present in the area.
The infrastructure is very poor, which makes it difficult to reach the people in many remote areas. Also, the region has been torn by conflicts for decades. In the 1960s, the construction of a huge dam deprived many farmers of their arable land, causing thousands to flee to India. Another 50,000 people fled when violent clashes between the government and the region's autonomy movement began in the early 70s.
In 1997, the conflict was officially resolved by means of a peace treaty. Since then, refugees have returned from India, only to find that Bengali settlers are now living on their land. These settlers have been given incentives by the government to settle in the Chittagong Hill Tracts in order to alleviate population pressure in the rest of Bangladesh. Both past and current conflicts center on the issue of autonomy and land rights held by various ethnic groups and unfortunately remain because of non-implementation of the peace treaty.
© 2013 Doctors Without Borders/Médecins Sans Frontières (MSF)