100,000 Medical Consultations in 100 Days

HEALTHCARE FOR ROHINGYA REFUGEES AND LOCAL COMMUNITIES IN BANGLADESH

Cox’s Bazar - If Morisha's family had waited a matter of minutes before bringing her to the UN Migration Agency(IOM)'s health post in the Balukhali makeshift settlement, she would be dead. Full term, in her first pregnancy, the 20-year-old started experiencing severe convulsions and bleeding from her mouth two weeks ago.

Terrified, her husband and brother carried her to the health post from their self-built, bamboo and plastic sheet shelter in the settlement.

Morisha's sister recounts the details of her siblings pregnancy complications. Photo: Olivia Headon/UN Migration Agency 2017

Morisha is one of over 625,000 Rohingya to flee Myanmar following an upsurge of violence in North Rakhine State on 25 August. She is also one of thousands who have been treated by IOM doctors after arriving in Bangladesh. When IOM Dr. Charl's Erik Halder assessed Morisha's condition, he diagnosed her as suffering from eclampsia. After stabilizing her, he arranged for an IOM an ambulance to take her to the Cox's Bazar District Hospital for emergency treatment.

Morisha subsequently gave birth and came back to the IOM health post to have the stitches removed from a C-section. "She is still weak and has pain in her head and neck," said Morisha's sister, who is helping care for her andher two-week-old niece.

Morisha was released from the district hospital after nine days of treatment and is now back in the overcrowded refugee settlement where she lives, which brings a whole range of worrying health risks to mother and baby.

Through post-natal care, IOM doctors will help Morisha to cope with these unique challenges, as well as, the more typical ones that new mothers face, like is the baby sleeping enough, am I holding her right and how many times a day should I breast feed.

A man waits to be seen by the doctor at a community health clinic, which serves both Rohingya refugees and the Bangladesh community. Photo Olivia Headon/UN Migration Agency 2017

A community health promoter talks patients through important health messages, while they wait to see the doctor at the Kutupalong Community Clinic. Photo: Olivia Headon/UN Migration Agency 2017

A doctor at IOM's Primary Healthcare Clinic in Kutupalong. Photo: Olivia Headon/UN Migration Agency 2017

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IOM has been providing vital healthcare to Rohingya refugees and to the local Bangladeshi community living in Cox's Bazar since 2013. Since 25 August, it has scaled up its operations and now runs 13 health posts and one primary health care centre. It also supports nine government health facilities and works with over 350 community health workers – making it one of the largest health responders on the ground.

This has allowed IOM to help 690 women give birth since the start of the influx. IOM health workers have also come to terms with the complexity and trauma of providing healthcare in the refugee settlements, where many people never had access to healthcare before they arrived in Bangladesh.

Fifty-five-year-old Mulham brought his nine-year-old son and 14-year-old daughter to IOM’s health post in Balukhali as soon as they made it across the border two months ago. When their village came under brutal attack in Northern Rakhine State, they gathered what little essentials they could and ran from their home.

Mulham holds up his son's clothing to reveal the near healed wounds on his legs. Photo: Olivia Headon/UN Migration Agency 2017

Both children were wounded by shotgun pellets as they fled through fields near their house. Mulham had to carry his daughter on his shoulders. His son, who was also shot in his feet and legs, was still able to walk the ten-day journey. But before they could cross the border, after living in the open under for about 15 days under heavy rain, as they children’s wounds became infected.

Mulham with his son and daughter in the Balukhali refugee settlement. Photo: Olivia Headon/UN Migration Agency 2017

“When they arrived, the children had multiple gunshot injuries, which were severely infected,” said Dr. Halder. “But we were able to treat them right here in the settlement.”

A surgeon preps to go into surgery. Photo: Muse Mohammed/UN Migration Agency (IOM) 2017

Surgery underway at an IOM-support Health Complex, which serves both refugees and the local Bangladesh community. Photo: Muse Mohammed/UN Migration Agency (IOM) 2017

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IOM has worked closely with the Government of Bangladesh in its health response since 2013. This includes taking part in monthly government-led district health meetings, where the governments’ strategy that to provide equal support to Rohingya refugees and Bangladeshis in Cox's Bazar has been formulated. Since 25 August, all healthcare services in the district have been massively scaled up.

"Initially, those who crossed the border were traumatized in every aspect, particularly with regards to health," Dr. Md. Abdus Salam, Civil Surgeon, who is responsible for overseeing healthcare in the Cox's Bazar District.

Dr. Md. Abdus Salam, Civil Surgeon, in his office in Cox's Bazar, Bangladesh. Photo: Olivia Headon/UN Migration Agency (IOM) 2017

"Most were injured – bullet injuries, mine blasts and sexual assaults. They were also poorly immunized and malnourished. We provided support to new arrivals during the acute crisis phase in three parts: curative, preventive and promotive. In curative, we deployed 17 mobile medical teams and have 20 community clinics in two Upazilas [sub-districts], six health centres, two health complexes and two district hospitals. Our partners, including IOM, also deployed more then 30 medical teams to respond to the urgent health needs of those crossing the border.”

Rohingya refugees cross the border into Bangladesh. Photo: Olivia Headon/UN Migration Agency (IOM) 2017

"We started a special campaign to prevent outbreaks, which included vaccinating against measles and rubella, and administering vitamin A capsule and oral polio vaccine to reach hundreds of thousands of men, women and children. I was particularly worried about a measles outbreak, because we saw many cases in people just arriving across the border. Our measles vaccination campaign will be ongoing as people continue to arrive,” he added.

With so many refugees settling in Cox's Bazar in such a short space of time, who had never been immunized, Dr. Salam was also concerned about that the water-borne diseases and sanitation. Cholera was a particular concern. "The Government of Bangladesh and the humanitarian community has nowreached over 700,000 people over the age of one with an oral cholera vaccine," he noted.

Children queue to take be vaccinated against Cholera are the Rohingya refugee settlements in Cox's Bazar. Photo: Muse Mohammed/UN Migration Agency (IOM) 2017

IOM health staff administers a dose of oral Cholera vaccine to a young boy. Photo: Muse Mohammed/UN Migration Agency (IOM) 2017

A boy shows his inked figure, which indicates that he has received the oral Cholera vaccine. Photo: Muse Mohammed/UN Migration Agency (IOM) 2017

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IOM, partners and Government medical teams are now responding to an outbreak of diphtheria, which has become a major concern.

Every day, IOM doctors treat a range of different cases in Cox's Bazar. In typical day they will see anywhere from number of 1,500 to 1,900 patients. The most prevalent cases are acute respiratory tract infections, diarrhoea, dysentery, chronic respiratory problems, musculoskeletal pain, skin diseases, malnutrition and maternal health care issues.

A doctor checks a patient's breathing. Photo: Muse Mohammed/UN Migration Agency (IOM) 2017

A patient waits to be seen by the doctor at the Kutupalong community clinic. Photo: Olivia Headon/UN Migration Agency (IOM) 2017

An IOM doctor consults with mother and son at the Rohingya refugee settlements. Photo: Muse Mohammed/UN Migration Agency (IOM) 2017

A woman waits to see the pharmacist at the Kutupalong Primary Healthcare Clinic. Photo: Olivia Headon/UN Migration Agency (IOM) 2017

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Senowara, 30, was carried to IOM's Primary Healthcare Centre in Kutupalong last month by her husband. She had been fine in the morning. But in the afternoon, she started to pass watery stools. The first time it happened she thought that she would be okay, but after the fourth time in one hour, she remembers very little.

Senowara holds her child during her follow up at IOM's Kutupalong Primary Healthcare Centre. Photo: Olivia Headon/UN Migration Agency (IOM) 2017

"Senowara was in medical state of shock when her husband brought her to us," said Dr. Raisul Islam, an IOM doctor in Kutupalong. "Her pulse was very rapid and she was near to death. We thought she might only have one to two hours left.”

Dr. Islam and Senowara discuss her wellbeing since her health scare. Photo: Olivia Headon/UN Migration Agency (IOM) 2017

Dr. Islam worked fast to stabilize her condition and then had her transferred to the district hospital in Cox's Bazar in an IOM ambulance. The diagnosis was acute watery diarrhoea, which may have been brought on by one of several factors linked to poor living conditions in the refugee settlement where she lives. The most likely of these was dirty drinking water.

An IOM community health worker. Photo: Muse Mohammed/UN Migration Agency (IOM) 2017

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