One year ago today, on 8 March 2020, the battle against the coronavirus pandemic was on in Bangladesh with the first COVID-19 case being reported in the country. As the news reached the shores of Cox’s Bazar - home to nearly one million Rohingya refugees and vulnerable host communities - concerning as it was, humanitarian partners shared the commitment to change the course of the pandemic.
One year on, while the fight is far from over in the world’s largest refugee camp, Bangladesh has so far successfully limited the health impact of COVID-19 in Cox’s Bazar while striving to sustain essential health services delivery under unforeseen circumstances.
Upholding health service quality in a complex setting: preparing for a pandemic
In preparation for the COVID-19 pandemic, in 2020 WHO initiated and coordinated the establishment of 14 Severe Acute Respiratory Infection (SARI) Isolation and Treatment Centres (ITCs) in Cox’s Bazar with a capacity of nearly 1200 beds.
WHO Representative in Bangladesh, Dr Bardan Jung Rana, at UNHCR/Relief International SARI ITC. The facility was inaugurated in May 2020, days before the first COVID-19 case was detected in the Rohingya refugee camps. WHO Bangladesh/Tatiana Almeida
Since March 2020, Health Sector partners in Cox’s Bazar collaborated to set up isolation and treatment facilities to meet the projected demand of COVID-19 positive cases in the camps and host communities which was expected to vastly overwhelm the existing capacity. The newly established SARI ITC facilities can provide quality treatment for mild, moderate and severe cases of COVID-19, including provision of oxygen through WHO and donors’ support with oxygen generators to ensure access to essential, lifesaving oxygen therapy care for the affected populations.
Serving as a foundation for optimized clinical care to ensure the best possible chance of survival of COVID-19 patients, WHO is coordinating weekly specialist operational, clinical and critical care forums with the participation of SARI ITCs staffs.
WHO Head of Sub-Office, Dr Kai von Harbou, Public Health Officer Dr Simon Kaddu Ssentamu and IPC Specialist Rebecca Rachel Apolot conducting a supportive supervision visit at UNICEF SARI ITC under construction in August 2020. WHO Bangladesh/Tatiana Almeida
Keeping the promise of health for all: the leading role of Health Sector coordination in Cox’s Bazar
Working towards the realization of better health for everyone in Cox’s Bazar, WHO envisions to secure a safe and dignified future for the Rohingya refugees and host communities. WHO Bangladesh/Tatiana Almeida
Just like elsewhere in the world, fears of being infected have impacted Rohingya refugee’s health care seeking behaviors. WHO and its partners have been engaging communities, health partners and other key stakeholders to inform the population about risk factors and protective measures for COVID-19 and dispel rumours and misconceptions that could hinder important health outcomes.
Breaking the chains of COVID-19 transmission
Dr Morshad Ahmad, a WHO Camp Health and Disease Surveillance Officer (CHDSO) verifying with the mother of a confirmed COVID-19 patient those who have been in contact with the patient. WHO Bangladesh/Tatiana Almeida
Under the overall supervision and coordination from WHO, camp-wise Rapid Investigation and Response Teams (RIRTs) have been responding to alerts within 24 hours and referring COVID-19 patients to Severe Acute Respiratory Infection (SARI) Isolation and Treatment Centers (ITCs) with the help of the Dispatch and Referral Unit (DRU), in an effort that has been instrumental to slow down the spread of the virus in the world’s largest refugee camp.
Testing is the key: protect yourself and others
To prioritize testing, a sentinel surveillance system was rapidly established with all samples being processed at the Cox’s Bazar Medical College Institute of Epidemiology, Disease Control and Research (IEDCR). Additionally, under Expanded Community Based Surveillance, Community Health Workers (CHWs) also contributed to identify individuals with symptoms associated with COVID-19. Symptomatic people are then referred to the nearest health facilities or directly to one of the 26 sample collection sites.
Supported by WHO, the IEDCR Field Laboratory is being instrumental to provide testing and timely diagnosis for COVID-19 for Cox’s Bazar. To date, over 100 000 COVID-19 PCR tests have been conducted by a dedicated and highly skilled laboratory team. WHO Bangladesh/Tatiana Almeida
A vital part of the COVID-19 response in the district, the Field Laboratory is playing a key role in the COVID-19 seroprevalence study through testing and analyzing the 3699 blood samples collected in the camps for the presence of antibodies against SARS CoV-2. Testing of the samples has been completed and the results of the survey will be made available through IEDCR, Dhaka and the Government of Bangladesh (GoB). WHO Bangladesh/Tatiana Almeida
A culture of patient safety: Championing infection prevention and control
Preventing harm to patients, health workers and visitors due to infection in health care facilities is critical to achieve quality care, patient safety, health security and to reduce healthcare-associated infections. To enhance preparedness for COVID-19 in Cox’s Bazar, WHO has trained nearly 3000 healthcare workers from health facilities operated by partners and the government on infection prevention and control (IPC)
In May 2020, an IPC Technical Working Group was established in Cox’s Bazar to strengthen IPC committees at health facility level with over 50 partners meeting on a bi-weekly schedule to share best practices. The District IPC committee for Cox’s Bazar was officially created in February 2021 envisioning improved patient and healthcare workforce safety.
WHO IPC Specialist Rebecca Rachel Apolot (left) guiding a visit to the Head of the European Union Humanitarian Aid (ECHO) in Bangladesh, Daniela D’Urso (right) at the UNHCR/Relief International SARI ITC. WHO Bangladesh/Tatiana Almeida
Ensuring the continuity of essential health services
The
effective provision of essential health services remains a priority in Cox’s
Bazar. WHO and partners employ daily efforts to ensure that health services such
as routine immunization, sexual and reproductive health (SRH), gender-based violence
(GBV), and mental health and psychosocial support, are able to continue despite
constraints imposed by the COVID-19 pandemic. Health facilities have put in
place adjustments to the COVID-19 context comprising the establishment of
screening, triage and waiting areas for screening, isolation and referral of
suspected patients to SARI ITCs.
In November 2020, Moriam Begun, aged 21, had her second child at the Cox’s Bazar refugee camp with the help of a skilled midwife. WHO Bangladesh/Tatiana Almeida
Making our work possible: operational support and logistics
A remote area in the very south of Bangladesh, Cox’s Bazar presents an added challenge to operational support and logistics teams with health partners requiring immediate operational support to access supplies, equipment and consumables, with particular emphasis on personal protective equipment (PPE) and oxygen concentrators in the context of COVID-19. As such, in 2020 WHO distributed 1.68 million of PPE items to partners in Cox’s Bazar.
WHO Technical Officer for Administration and Finance, Palaniappan Kesavan, along with many WHO staff in Cox’s Bazar embodies the organization’s sense of meaning to realize its mandate in the world’s largest refugee camp during the COVID-19 pandemic. WHO Bangladesh/Tatiana Almeida
“This past year was extraordinary in many ways. For one, the Health Sector backed the emergency response with technically sound synergies and intersectional collaboration. On the frontlines, Cox’s Bazar humanitarians and health care workers have relentlessly shown their commitment to provide vital humanitarian and medical assistance, however not without significant personal sacrifices. Pushing to successfully change the course of the pandemic and help sustain important health outcomes, the Government of Bangladesh, donor countries and partners from around the world made sure that the Rohingya people were not going to be left behind. Our deepest appreciation and heartfelt thanks to those supporting WHO and the Rohingya refugee crisis at this moment in time”, says WHO Head of Sub-Office, Dr Kai von Harbou.
In the past year, the WHO humanitarian response in Cox’s Bazar relied on the relentless support from UKAID/DFID, Embassy of Japan, World Bank, European Civil Protection and Humanitarian Aid Operations (ECHO), and GAVI. Together, they have made clear that the Rohingya plight will not be forgotten, not now, not ever.