The nightmare scenario has arrived for the Rohingyas living in refugee camps in Bangladesh. The diseases and living conditions have reached an unacceptable and inhumane level.
Currently, the prevalence rate of scab in the fields is 40%. It is estimated that more than 400,000 people have contracted this tropical disease extremely contagious and forgotten. It would be one of the largest recorded outbreaks of scabies, an outbreak that also takes place in the largest refugee camp in the world, home to nearly a million Rohingya refugeesone of the most persecuted minorities in modern history.
During the last six years, since the Rohingya were expelled from neighboring Myanmar, the humanitarian response has been a failure. Doctors Without Borders has been alerting the world to the extreme risk of a serious disease outbreak. We warned that conditions on the pitch could slowly deteriorate until it was too late. And now it has happened.
Scabies is a parasitic infection caused by microscopic mites (‘Sarcoptes scabiei’) that burrow into the skin and lay their eggs. The skin does not tolerate this infestation well, and the immune response causes an itchy rash. Although it is not fatal, it reduces the quality of life, especially those who do not have adequate accommodation or cannot be treated. The intense itching can lead to sleepless nights and, in turn, deteriorate mental health.
It was a predictable situation: the trifecta1 of some extremely crowded camps, poor water and sanitation services leading to deteriorating hygiene in the camps, and all this while denying them the right to move freely or to work. And this takes place against the backdrop of some Overwhelmed health services and decreased funding for the camps by international donors.
What else could be expected to happen by indefinitely holding a million refugees in makeshift camps?
The question now is not so much why the world ignored the warning signs, but what it will take for the international community, donors and the United Nations take more responsibility for the Rohingya.
I have been working with the Rohingya community for over six years. MSF teams have been providing health care to this village in their homeland, Myanmar, since 1993 and have witnessed the successive rulings on international responsibility.
Controlling this scabies outbreak would require a mass drug administration, in addition to effective vector control in all the camps. Basically, this would require all households to clean their bedding and clothes at the same time. None of this is possible for the Rohingya, who have less than adequate supplies of soap and water in the crowded camps.
The fields were only meant to be a short-term option. But, after six years, the temporary structures are becoming long-term liabilities, looking more like urban slums than homes. Without a change in the unsustainable containment strategies of donor and host states, the camp population will remain highly vulnerable to infectious disease outbreaks.
This latest scabies outbreak should be enough for governments to work towards durable solutions with greater urgency and determination. But unfortunately it is not so. It seems absurd to justify why this outbreak is a outrageous public health crisis that no population should have to endure.
The nutritional situation in the fields is also deplorable.. We are concerned about the number of cases of malnutrition that arrive at our clinics. In 2022, in just two of our facilities we recorded 3,200 cases of malnutrition among pregnant women and lactating mothers, of which 40% suffered from anemia, and between 25% and 28% of the babies born were underweight. General acute malnutrition rates among children under five stood at 19% in 2022, rising to 21% by mid-2023.
If we add to this that the World Food Program has reduced food aid Rohingyas at $8 a month, we can expect an increase in malnutrition and anemia, higher ratios of babies with low birth weight and, in turn, higher mortality rates among women and children. There is a whole generation of Rohingya children facing the possibility of stunting due to lack of sustained nutrition. To those same children too denied the right to a full education. The Rohingya camps at Cox’s Bazaar in Bangladesh appear to be a place where humanitarian standards do not apply, camps largely forgotten and neglected by the rest of the world.
A whole generation of women, boys, girls and men who are reduced to simple words like “refugees” or “stateless”. They are more than that They are people who have endured persecution, seen their villages burned down, their family members killed, only to face a life behind barbed wire in conditions that neither you nor I would probably ever endure. They are people who survive every day, despite these circumstances, like mothers, fathers, daughters and sons. They are people like the rest of us, they are artists, teachers and much more.
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Precarious situations in refugee camps can often arise when there is an inability or unwillingness of international organizations to be aware of gradually emerging threats. In the case of the Rohingya in Bangladesh, in fact, there are a million pressing reasons not to be complacent.
1 In horse racing, a bet in which the order of arrival of the first three is correct.