Bangladesh: Leading a collective effort to eliminate Hepatitis C

Viral hepatitis, particularly types B and C, is a global health crisis, tragically claiming over 1.3 million lives annually. The situation here in Rohingya refugee camps in Cox's Bazar is even more dire. Overcrowded conditions and limited access to healthcare have created a perfect storm for its spread. A recent MSF study indicates a shocking reality: nearly 20 per cent of Rohingya refugees tested in these camps have an active hepatitis C infection.

We, the Balukhali team of MSF, are conducting screening and testing at three specific camps: Camp 9, Camp 8E, and Camp 10. Our estimated target population is around 57,000 people, and our mission is to screen them all, providing vital hepatitis C services.

I refer to hepatitis C as a ‘silent killer’ because, in many cases, it presents with no obvious signs or symptoms. People can be infected for years, even decades, without knowing it. Sometimes, there might be very mild, flu-like symptoms such as a slight fever, nausea, or vomiting, but often, nothing at all. This insidious nature means that over time, the virus gradually damages the liver, leading to severe conditions like cirrhosis or even liver cancer. Because symptoms don't appear early, many people don't seek testing or treatment until it's too late.

Our team is focusing on three critical areas: raising awareness, providing comprehensive testing and treatment, and breaking down the associated stigmas.

Our goal for raising awareness is to actively inform the community about hepatitis C, explaining the risks and emphasising the crucial importance of seeking early treatment.

When it comes to testing and evaluation, MSF teams conducted 12,000 tests between 2020 and 2024. Then, the Balukhali team specifically began testing in mid-May (2025). In this short time, we've already screened 2,275 people, and 496 individuals tested positive with the initial screening. This is just the first step. We are ensuring that those diagnosed receive treatment. 

Our third crucial area is breaking down stigma. We have an incredible team working in the field every morning. This team of 23 people, including 16 community-based health volunteers (with two team leaders) and five nurses, goes door-to-door in the camps. During their visit they conduct tests and provide essential health education about hepatitis C. They explain what the disease is, how it can harm individuals, and clarify that an RDT-positive result [obtained by an on-the-spot rapid diagnostic test] means further testing and potential treatment.

The community's feedback and support have been overwhelmingly positive. Many people have been waiting for this treatment for a long time. Given the limitations of healthcare and the lack of government-level treatment options, many were anxious about when they would ever receive care. When our teams go into the community, they are almost always cordially received, and people are eager to talk.

There are some minor challenges, though. For example, a fear sometimes exists within the community that if someone tests positive, it might pose difficulties for marriage or lead to social ostracisation. However, this is not widespread. For the most part, when individuals are given proper health education, they understand. Because there are no symptoms, unlike a fever that would immediately send someone to the clinic, people don't feel acutely ill. Yet, they understand the implications and the cost of treatment, knowing they cannot afford it. They are keen to receive treatment through our program.

Our health educators and volunteers tirelessly explain how the disease spreads: not through casual contact, but through blood-to-blood contact.

This fight against hepatitis C requires a collective effort. It cannot be prevented by one person alone. Especially in this densely populated community, I believe that by sharing the awareness I've gained today, we can reach everyone. Our ultimate goal is to eliminate hepatitis C in the Rohingya refugee camps by expanding testing, treatment, and awareness. By doing so, we can significantly improve health outcomes and create a brighter future for this entire community.