One of the most troublesome features of Dhaka city is its constant traffic condition. Commuting from point A to point B in this city during weekdays takes two to three hours, which should have taken at most 30 minutes. This problem is not sudden, rather it gradually developed in front of us with all the bells and whistles. There have been several evidence-based studies done since early 1990s, then in early 2000s and even in this decade to assess Dhaka's traffic systems and possible solutions. The policy recommendations from these studies required concerted effort to implement systemic changes that needed to continue for decades even when governments changes. As of 2017, our measure of "success" is that in Dhaka city 3.2 million working hours is lost in traffic every day and the cost of road construction per kilometre is the highest in the world. The forecasting made decades ago to address the traffic conditions were not taken seriously and we are facing its fallout effect. The same analogy can be applied to various disease break-outs in Rohingya camps and its near-future systemic fallout.
The aid and relief supplies have been pouring in and effort by Inter Sector Coordination Group (ISCG) to coordinate material resources and human resources from dozens of local and international agencies is exemplary. However, resolving only the living conditions and food sustenance addresses a short-term goal and it is highly celebrated due to its immediate tangible results. We need to comprehend that such living conditions becoming long-term and food as handout will eventually have negative systemic effects.
The Rohingyas, who have entered Bangladesh recently, have been suffering from diseases like malaria, hepatitis B and hepatitis C. Moreover, since their arrival some of the diseases that Bangladesh had almost eradicated re-emerged, within the camps, like diphtheria, measles etc. There have been confirmed diphtheria cases in host communities as well. International and local health officers were not only alarmed but also surprised by such revelation. This incidence of diphtheria highlighted that the Rohingya population literally never received even the basic healthcare services and immunisation programmes; hence diseases like diphtheria could become endemic. These infectious diseases might have been dormant or isolated before but congested living condition, malnutrition, poor sanitation services all acted as catalyst for the breakout.
The initial surge of relief items and aid are not the baseline of resource availability, rather if strategic and sustainable resource procurement plans are not taken, then these camps will face multiple inter dependent crises simultaneously. The most visible problems of interpersonal conflict, safety and security could be addressed using force. However, the latent issues of disease surveillance, clean water, proper sanitation would eventually make these camps a hotpot for infectious diseases. There is no definite certainty of containing the population as the movement in the Cox's Bazar area is highly fluid. This poses a systemic threat to the neighbouring host population and eventually the general population.
We have to prioritise proper health care and other services for the Rohingya population, not for the sake of them but for the sake of ourselves. The camps are situated in areas that are prone to suffer serious damage from upcoming storms during the monsoon season. Unless we take preventive measures to limit the exposure and breakout of diseases post-disaster, then the systemic risk will increase logarithmically. Bangladesh has had achieved measurable success in eradicating infectious diseases that effect its population. Even with modest resources and challenging environmental factors, the concerted effort by government, local-international non-governmental organisations (NGOs) and proactive leadership from communities mitigated endogenous factors of infectious diseases within Bangladesh. The Rohingya situation is an exogenous factor that could undermine the overall healthcare successes Bangladesh has achieved so far.
The monsoon season will start soon and without pre-emptive measures it will be too late to stop diseases from breaking-out. As of January 2018, the camp population showed several thousand cases of cholera, measles and most recent diphtheria. The healthcare services are trying their best to vaccinate the Rohingya population, however due to logistical issues many are left untreated. More importantly as the population is dynamic hence there could be individuals who have not been screened at all and hence we face the situation of unknown-unknowns of infectious diseases in the camps.
As of first week of January 2018, close to 4000 suspected diphtheria cases were reported with more than 30 deaths. Diphtheria treatment requires diphtheria anti-toxins (DAT) and isolation. According to Medicine Sans Frontières (MSF), globally only 5000 vials of DAT are available -- posing a systemic gap. Besides, the camp conditions present systemic challenges to maintenance of isolation protocol for the confirmed cases. Considering the circumstances, mass population of Bangladesh are at grave risk if such diseases start spreading outside the refugee camps. Eventually, Bangladesh and its people, specially the young demographic dividend we prize so much, would have to pay the price, if the surveillance and monitoring of diseases within these camps are not prioritised. A systemic observation emphasises that the government, responsible NGOs and ISCG publicly acknowledge the risk of disease breakout during the monsoon season and make public their preventive plans. As of now, the current trajectory does not show the capacity to contain spread of diseases in case a natural disaster strikes.
In practical terms, the Rohingya population that have arrived recently need to be kept within a controlled environment. This might sound harsh, but this is a practical policy measure to ensure reciprocal health safety. Group conflict, interpersonal tensions are unavoidable in such cramped and stringent living conditions and those incidents can be controlled using force. However, virus and bacterium are airborne, water borne and can spread from physical contacts or sharing spaces. There must be a collective awareness rather than laissez-faire attitude about the threat posed by these invisible elements -- the infectious diseases.
Such complacency and negligence among the general population towards Malaria in South East Asia resulted in drug-resistant malaria strains. For malaria, its symptoms are trivial and short-term; hence, in many cases, a general anti-biotic treatment is administered without proper diagnosis and not emphasizing easy preventive measures like mosquito nets. The systemic heath risk from the Rohingya situation demands a behavioural engineering strategy that is designed by integrating local context, to change the mindset of the camp and host population. This is needed to replace complacency with vigilance and to implement fastidiously treatment and surveillance. Otherwise in the near future just like the systemic traffic condition of its capital city, Bangladesh might face systemic health crisis.
The writer is Archer Fellow Lee Kuan Yew Scholar. safwanrob@gmail.com