The health response to the Rohingya refugee crisis post August 2017: Reflections from two years of health sector coordination in Cox’s Bazar, Bangladesh

Abstract

On August 25 2017, an unprecedented influx of Rohingya refugees began from Rakhine State in Myanmar into Bangladesh’s district of Cox’s Bazar. The scale and acuteness of this humanitarian crisis was unprecedented and unique globally, requiring strong coordination of a multitude of actors. This paper reflects on the health sector coordination from August 2017 to October 2019, focusing on selected achievements and persisting challenges of the health sector strategic advisory group (HSSAG), and the health sector working groups including epidemiology and case management, sexual and reproductive health, community health, mental health and psychosocial support, and emergency preparedness. In the early days of the response, minimum service standards for primary health care were established, a fundamental initial step which enabled the standardization of services based on critical needs. Similarly, establishing standards for community health outreach was the backbone for capitalizing on this important health workforce. Novel approaches were adopted for infectious disease responses for acute watery diarrhoea and varicella, drawing on inter-sectoral collaborations. Sexual and reproductive health services were prioritized from the initial onset of the crisis and improvements in skilled delivery attendance, gender-based violence services, abortion care and family planning were recorded. Mental health service provision was strengthened through community-based approaches although integration of mental health programmes into primary health care has been limited by availability of specialist psychiatrists. Strong, collaborative and legitimate leadership by the health sector strategic advisory group, drawing on inter-sectoral collaborations and the technical expertise of the different technical working groups, were critical in the response and proved effective, despite the remaining challenges to be addressed. Anticipated reductions in funding as the crisis moves into protracted status threatens the achievements of the health sector in provision of health services to the Rohingya refugees.

“Most of the cases are very similar.”: Documenting and corroborating conflict-related sexual violence affecting Rohingya refugees

“…These findings align with research by Tay et al (2019) and Parmer et al (2019) which both indicated that Rohingya refugees were reluctant to report sexual violence or seek care and showed limited help seeking behaviors, likely due to past restrictions on rights and health care in Myanmar [ 21 , 22 ]. These findings indicate the importance of providing cultural relevant care, potentially outside of traditional medical care delivery pathways, such as through community volunteers or integrated care provision models with other services [ 21 , 23 , 24 ]. Training on screening for CRSV should include skill building on trauma-informed manners of engaging with conflict-affected populations as part of routine medical care [ 25 – 27 ].…”

“…The estimations of increased pregnancy and birth rates shared by our respondents are consistent with published studies and observations by other organizations suggesting birth rates above the historical baseline among Rohingya refugees in Bangladesh [ 20 , 22 , 33 ]. Pregnancy termination was challenging for survivors, given the cultural and religious setting, stigma, underreporting of sexual violence and resulting pregnancy, very limited services for abortion despite some successfully implemented care models with limited reach, extreme complications from unsafe abortions, and legal restrictions [ 24 , 34 , 35 ]. The combination of an increased number of births and the difficulty in accessing safe pregnancy termination would seem to indicate that Rohingya women were sometimes forced to continue pregnancies that were unintended or unwanted.…”

The World Health Organization's Actions Within the United Nations System to Facilitate a Whole-of-Society Response to COVID-19 at Country Level

“…Guided by the WHO Emergency Response Framework ( 23 ), WHO Bangladesh established an incident management system soon after the largest influx of refugees from Myanmar in 2017 that effectively managed many outbreaks and natural disasters prior to COVID-19 ( 24 , 25 ). Both the WHO incident management system and the ISCG were leveraged for COVID-19, highlighting the benefit of having existing mechanisms using a whole-of society response for emergencies ( 26 ). The COVID-19 response was also extended to the entire population of Cox's Bazar district.…”

Design and Implementation of the Amenah Early Marriage Pilot Intervention Among Syrian Refugees in Lebanon

“…31 The importance of involving refugees in delivering health services in humanitarian settings has also been noted in other contexts. 32 In displacement settings, however, researchers ought to recognize how economic and legal factors affect implementers from excluded communities who genuinely commit to the research project but whose contributions are constrained by multiple and competing demands. The Syrian CWs who implemented the Amenah intervention shared the same socioeconomic background and displacement experience as the girls' families.…”