The speed and scale with which over one million Rohingya refugees have crossed over the border to Cox’s Bazaar camp in Bangladesh has led to a critical emergency situation. (1) Rohingya are the most persecuted stateless minority in the world, resulting in poor health and nutrition. They have been given temporary shelter in makeshift camps without basic amenities on the outskirts of small villages. Most of the refugees have had no access to healthcare for decades due to inadequate health services and restrictions on their freedom. (2). Local and international medical non-governmental organizations (NGOs) are providing much needed emergency medical care and building infrastructure in the camps which are scattered over 2,000 acres of hills.

We recently returned from one of over a dozen medical missions taken over the past few months to Ukhiya, Cox’s Bazaar, Bangladesh, providing medical care and distributing medications using a mobile clinic model across the Kutupalong camp. We were part of teams of American and Canadian volunteer doctors in partnership with a local NGO Charity Society of Bangladeshi Doctors. We saw hundreds of patients every day, and walked through the camps to reach otherwise inaccessible areas. Due to security reasons, refugees are not allowed to leave the camps, so mobile clinics are the only source of healthcare.  

There has been continuing deterioration in the health status of Rohingya refugees. Because of the lack of clean water, sanitation and hygiene, the majority of the population have a transmittable disease. Chronic malnourishment has led to common deficiencies such as blindness from a lack of vitamin A, and goiter from iodine deficiency. Malnutrition is reported to be as high as 50% in children. (3) There is a lack of resources for ongoing or long term healthcare, so patients presenting with fractures or diabetes struggle to receive basic care.

In adults we commonly saw acutely worsened, untreated cases of non- communicable diseases (NCD) such as diabetes. Necessary medications are generally unavailable due to a lack of a diagnostic laboratory or refrigerator infrastructure. The healthcare system of Bangladesh, a developing country, does not have the capacity to deal with  a sudden surge in the population that is in critical need of medical attention. (4)

Cultural and social barriers, compounded by the challenging situation have caused widespread psychological disorders such as anxiety and post traumatic disorders, among the refugees. (5)

Non-communicable disease frequently go untreated due to the cost of receiving care. Additionally, physical limitations, lack of access to a public health center, and a lack of transportation, create barriers to access. (3) While many large and small medical NGOs operate in the region, few standards exist on how to deliver and coordinate care. (5)

As governments and relief agencies respond to the unfolding crisis, the international medical community should urgently escalate their response by delivering human expertise, skills, and medical supplies to support the local staff and enhance their capacity. A lack of inpatient bed facilities and specialized tertiary level of care, has led to a situation where the healthcare provisions are not adequate to meet the demands of refugees. (1) The monsoon seasons brings even further challenges with vector borne and communicable disease.

Increasing the health literacy of the refugees about NCDs and communicable diseases, early screening and mental healthcare are gravely needed. Further research and data collection is needed to quantify the healthcare needs and to coordinate the response. (6) Our experience demonstrated that private not-for- profit organizations can collaborate with local partners and make an impact in this continuing crisis. To prevent a catastrophe, governmental organizations need to provide for the immediate and long term needs of the refugees.

Salim Saiyed is vice president and system chief medical informatics officer at UPMC Pinnacle in Pennsylvania. He holds an academic appointment at Johns Hopkins University School of Medicine. 

Competing Interests:

The authors have no competing interests to declare.

References:

1. Inter Sector Coordination Group. Situation Report: Rohingya Refugee Crisis: Cox’s Bazaar: March 2018 [Internet].  United Nations Office for the Coordination of Humanitarian Affairs; 2018 [cited 2018 Jun 12]. Available from: https://www.humanitarianresponse.info/sites/ www.humanitarianresponse.info/files/documents/files/iscg_-_sitrep_180311.pdf  
2. World Health Organization Department for Emergency Risk Management and Humanitarian Response.  WHO humanitarian response plans [Internet]. Geneva:  World Health Organization; 2016 [cited 2018 Jun 12].  Available from: http://www.who.int/hac/hrp_2016_6_april.pdf
3. Mahmood SS, Wroe E, Fuller A, Leaning J. The Rohingya people of Myanmar: health, human rights, and identity. Lancet. 2017 May 6;389:1841-50. doi:10.1016/S0140-6736(16)00646-2
4. Masud A, Ahmed MS, Sultana MR, et al. Health problems and health care seeking behaviour of Rohingya refugees. J Med Res Innov. 2017;1:21-9. doi:10.15419/jmri.27
5. Milton AH, Rahman M, Hussain S, et al. Trapped in statelessness: Rohingya refugees in Bangladesh. Int J Environ Res Public Health. 2017 Aug 21;14(8):pii:E942. doi:10.3390/ijerph14080942.
6. Pocock NS, Mahmood SS, Zimmerman C, Orcutt, M. Imminent health crises among the Rohingya people of Myanmar. BMJ. 2017 Nov 15;359:j5210.  doi: 10.1136/bmj.j5210