More than a quarter of the approximately 18,000 Rohingya refugees being held on Bangladesh’s silt island of Bhasan Char are reportedly suffering from a sudden outbreak of diarrhea. At least three children have died, according to news reports.
While diarrheal disease is preventable and certainly should not be fatal, it remains a challenge in many parts of the world where sufficient access to safe water, sanitation, hygiene, and health care is limited.
But Bangladesh could have avoided such an outbreak if the government, as previously planned, had allowed technical and humanitarian experts to visit Bhasan Char to determine safety and protection needs. Instead, the authorities relocated thousands of refugees to the remote island without first ensuring that it had adequate health care and access to resources on the mainland.
Dr Tanvir Anwar, a physician on the island, told The Daily Star that Bhasan Char’s meager health-care system is overwhelmed by the outbreak and that medical facilities – admitting 40-50 diarrhea patients per day – are turning away anyone with illnesses except for acute diarrhea. He said people are being treated in corridors and on the floor and that there is a “crisis of medicine as the disease is increasing rapidly.”
Refugees whom Human Rights Watch (HRW) spoke with on the island confirmed this, saying that as people experiencing other illnesses were turned away from the health-care facilities, health workers told them that they just didn’t have enough capacity. Furthermore, emergency supplies from the mainland have been delayed because of monsoon-season rain.
This chain of events was predictable and preventable. Since the Bangladeshi government proposed Bhasan Char as a solution to overcrowding in refugee camps in Cox’s Bazar, where nearly a million Rohingya refugees live, United Nations and humanitarian experts and rights groups have been raising red flags that the low-lying island’s remoteness and location in cyclone-prone waters, among other concerns, make it unfit for safe and sustainable habitation.
A recent HRW report found that health-care facilities on the island are gravely inadequate and that there is no capacity for emergency medical care. Fourteen people who had sought medical treatment on the island told us they received inadequate care.
In four cases, when following up with their families, we learned that the patients had died. In each of these cases the families believed their relative’s death was due to grossly inadequate emergency medical care on the island.
As one refugee said, “In the [mainland] camps if any of us became sick at least we would be able to go to a doctor or hospital or the NGOs [non-governmental organizations] could arrange better treatment, but here when our people are dying, no one cares.”
Authorities need to transport people who are seriously ill either by boat or helicopter to the nearest hospital on the mainland, which is three hours away by boat plus an additional two-hour drive by car. Transport by helicopter is sparse. Just getting off Bhasan Char for emergency care requires obtaining a series of permissions and overcoming hurdles that refugees say have impeded them from seeking life-saving care.
A 35-year-old refugee told us that he believes the additional time required to obtain permission to leave the island may have cost his wife’s life from complications during childbirth: “If they had taken her to the hospital in Chittagong [north of Cox’s Bazar] on emergency basis by fastest possible means, my wife might have survived.”
The island’s location and the Bangladeshi government’s lack of planning not only keep refugees from leaving the island in case of emergency, but also prevent people on the mainland from bringing emergency medical supplies, food, water, and other necessities to the island.
One doctor told The Daily Star that health workers from Noakhali, where the nearest mainland hospital is located, tried to travel to Bhasan Char with rehydration fluids and other medicines to respond to the diarrhea outbreak but they could not complete the journey because of bad weather.
The current crisis portends an even greater calamity during the monsoon season when both boat and helicopter services are suspended during inclement weather. The government has not indicated its plans should a cyclone hit and the refugees, along with several thousand Bangladeshi officials and volunteers, become trapped on the island without sufficient food, water, or medical care.
The Bangladeshi government should address this imminent crisis by immediately transporting any refugees who require medical attention or who wish to return to the mainland.
The government should initiate comprehensive policy and technical consultations with the UN refugee agency on future humanitarian operations on Bhasan Char. It should clarify plans to ensure emergency provision of safe drinking water, especially for children, as well as adequate medical care, food, and other necessities.
The government should follow through on its promises for an independent assessment of the habitability and emergency preparedness of the island and make any necessary adjustments, including returning refugees to Cox’s Bazar if it is deemed unsafe or unsustainable. Otherwise, the current health crisis is only a foreshadowing of the preventable loss of life that could come.